"Palpitations”   is by definition, an awareness of the beating of the heart.  Heart is one part of the body which beats non-stop all the time throughout one’s life.  Stopping of the heart beats is sure sign of death.When one feels the heart beating, it is an   uncomfortable sensation. It is commonly associated with a faster,   more than normal, heart rate (i.e. 60 to 90 beats) per minute.Palpitations   occur in normal persons following unaccustomed exertion, i.e. level of exercise   to which one is not used to.  When you walk very fast or run for something, the thudding begins in the chest.Another condition producing palpitations in an otherwise healthy person is anxiety or fear. When one is very tense or afraid of something like an exam, he or she would experience palpitations. This would be associated with dryness of mouth, sweating,   disturbed sleep, tremors e.t.c.  Those suffering from chronic anxiety states always have this symptom   present without any precipitating factor or disease likely to produce it. Tobacco, tea, coffee, alcohol and amphetamine, when used can lead to palpitations, by causing stimulation of the sympathetic nervous system. Women of menopausal age suffer from palpitations as part of the menopausal syndrome because of hormonal changes, though there may not be any underlying pathology. Among physical   disorders, diseases   of the heart are   the   major cause for producing palpitations. It may be the earliest manifestation   of   congestive cardiac failure, a condition where functioning of the heart becomes sluggish.  Similarly ischemic heart disease like angina may also manifest as palpitations. Various abnormalities of heart conduction   also lead to troublesome palpitations.   Infections of the layers of the heart like   viral diseases also lead to palpitations.  Nifedipine a drug used commonly for treatment of hypertension also produces a fast heart rate as a side effect producing uncomfortable awareness of heart beats in the individual. Bronchodilators   used for treating asthma like salbutamol and aminophylline also produce palpitations.  In many patients of asthma, the condition improves with medication, but they   suffer from the discomfort of palpitations after taking these drugs. Life saving adrenaline when given in some emergency like shock   is also known to produce palpitations. Some conditions   influence the beating of the heart by various mechanisms leading to increased heart rate. High fever is one such cause. Hypoglycemia (a state of low blood sugar) is another condition commonly producing palpitations. Hyperthyroidism (a state of over activity of the thyroid gland) is also a condition   causing   palpitations. In fact palpitations may be the earliest symptom of an overactive thyroid gland long before clinically visible goiter develops.Chronic anemia or acute blood loss results in palpitations. Anxiety states also produce palpitations those suffering chronically from palpitations need to be investigated suitably to differentiate between anxiety state   and any organic disease producing palpitations.The management depends on treating the cause of palpitations after diagnosing it. It is difficult in those suffering from anxiety states as they   need much persuasion and counseling to tell them they do not have any organic disease. Anxiolytic and antidepressant drugs would help them. Giving up alcohol and other addictions would help much to treat palpitations and also improve the general state of health of an individual. Those suffering from persistent palpitations benefit much from taking low dose of a drug blocking the adrenergic response to anxiety like propranolol. Similarly improving one’s nutritional status can also help much to reduce this problem. One need not worry if there is    uncomfortable thudding of the heart occurring daily or intermittently.  It only indicates that all is not well. Either one is stressed or anxious   or the body needs some relaxation. If regularly present it needs clinical examination and tests to find out the cause and treat it.Dr. Rachna PandeSpecialist Internal Medicine-Ruhengeri Hospital