If you can feel your heartbeat, it’s probably nothing to worry about

ABOUT half of Britons (47 per cent) sleep in their pyjamas while one in five prefers to dispense with wearing anything in bed.

That’s according to a recent YouGov survey carried out to find out our sleeping habits.

The same survey found that half of those who have pets allow them to sleep with them in bed and that three times as many people sleep better in bed alone than with someone else.

It also found that around half of us sleep on our side with 27 per cent doing so on their right and 23 per cent on their left.

Why am I going on about sleeping habits, you might ask? In fact, this article is about palpitations.

One of the most common times we might experience palpitations is at night and, believe it or not, the position in which we sleep can have an impact.

I try to avoid sleeping on my left side as I then tend to become more aware of my heart beating, which can be quite disconcerting.

This effect is mainly due to the greater pressure exerted on the heart from above in that position, although there may be other contributory factors. Therefore, people with heart conditions may prefer to sleep on their right side.

Those who suffer from reflux, on the other hand, might benefit from sleeping on their left due to the anatomy of the entrance to the stomach and the effect of gravity on the fluid within. Palpitations are extremely common. The definition on the NHS website is brief: “When your heartbeat becomes more noticeable.”

Many of us will get them while exercising. The vast majority of the time, it is nothing to be worried about.

If I were to expand on the definition, I would describe palpitations as an umbrella term for anything noticeably different or unusual about your heartbeat.

This could be a rapid heart rate, an irregular rhythm or a thumping beat. Often people describe having “missed” a beat or experiencing an extra one.

However, sometimes there may be something pathological going on. Supraventricular tachycardia (SVT)) is an example of an arrhythmia that occurs due to a particular abnormality of the heart’s electrical pathways. It causes episodes of a very fast heart rate above 100bpm (the normal resting range should be between 60 and 100bpm). Most often these resolve themselves after a few minutes.

If your heart rate is beating very rapidly and you are beginning to feel short of breath or dizzy or experience chest pain, it is important to get some medical attention as intervention to halt the fast heart rate (tachycardia) may be required.

However, in many cases of SVT, episodes are self-limiting and, in the absence of other symptoms, can be managed by reducing triggers such as caffeine, tiredness, alcohol or drugs.

Rarely, if they are frequent and ongoing for 30 minutes or more, they may require medical intervention.

The most common arrythmia by far is atrial fibrillation (AF) — cases have increased by 50 per cent in the last 10 years.

This is likely due to an increased recognition and diagnosis rate over this period as AF can sometimes go under the radar. Often people are unaware they even have it.

A normal heartbeat occurs when a node in the top chamber of the heart (atrium) emits an electrical impulse which then funnels through a bottleneck of conducting tissue in the centre of the heart. After a short delay, this signal reaches the lower chambers of the heart (ventricles) which contract in response. As they do so, blood is pumped out into the arteries. This is the pulse we feel.

AF occurs when the node in the atrium starts firing randomly and rapidly. Every now and again the signal gets through to the ventricles so the heart keeps beating but, instead of being regular, the rate is irregular and erratic.

The big risk here is that the blood flow becomes disordered, resulting in clotting and posing a significantly increased risk of throwing off clots to the brain. In other words, AF increases the risk of having a stroke.

Fortunately, we can bring this risk down by thinning the blood with anticoagulant medications (warfarin has been used a lot in the past but increasingly we use newer medications such as apixaban, rivaroxaban and others).

The problem is that, when people are not even aware their heartbeat is irregular, they do not receive this treatment.

AF is more common as we get older and when a normal rhythm switches to AF, you can experience that feeling of palpitations.

It is sometimes described as having a quivering or fluttering feeling in the chest. It’s always worth getting this checked by your GP.

For palpitations that might fit a category of arrythmia, it is likely that a routine ECG will be ordered as a first step. This gives a doctor a display of the electrical signals the heart is giving off.

It may also be useful to check thyroid levels in the blood which, if raised, can cause fast heart rates.

An ECG is, of course, only a snapshot and if the AF or other arrhythmia is not occurring all the time (described as paroxysmal), it might be useful to arrange an ECG device that can be worn for 24 or 48 hours.

There are also event recorders that can be worn and start reading the heart at the press of a button but these are not always available.

There are also devices which link to mobile phones and can be activated during an episode to record the heart rhythm.

Once diagnosed, AF can almost always be controlled and managed but the key is in identifying it. Around one in 45 people in the UK is confirmed as having AF and it is estimated that there are about 270,000 more undiagnosed.

As I wrote earlier, the vast majority of the time what people experience as palpitations are not worrying or concerning. A sensation of a missed or extra beat, for example, is down to something known as an ectopic beat.

This is simply a random extra beat in among an otherwise normal rhythm. It can often feel odd as the increased gap between it and the next beat means the heart fills a bit more than usual, causing the next normal beat to feel a bit more powerful as it is ejecting more blood. Almost everyone has these, some more than others, but they are not something to worry about.

Stress, lack of sleep or too much caffeine, nicotine or alcohol can predispose people to the sensation of palpitations. They are also often more common in and around the menopause and pregnancy.

In someone who is already stressed, the feeling of their heart beating out of their chest can perpetuate the anxiety and make the symptoms worse.

Addressing the lifestyle factors mentioned above is the best way to counter things.

It is no surprise that such palpitations occur more often occur at night when there are no other distractions. If not controlled, panic can set in, which only serves to increase the heart rate even more.

Deep breathing and meditation helps with this but also being aware that there is nothing wrong with the heart itself is as much a therapy as anything.

If you have the sensation of palpitations and can feel it is very irregular, have chest pain, feel dizzy or short of breath, it is worth getting checked. If none of these features are present, it is likely there is nothing to worry about.

So the next time you become aware of your heart beating, try and see it as a positive.

I wish you all a hale and hearty New Year.