Skipped a Beat? When "Butterflies in Your Chest" Are a Warning Sign | SJMC
Have you ever felt your heart suddenly race like a runaway horse? Or maybe it felt like your heart skipped a beat, leaving you slightly dizzy or short of breath?
Heart palpitations are incredibly common, but knowing when they are a normal reaction and when they signal a medical emergency is crucial. Dr. Louis Chea Chin Yung, Consultant Cardiologist and Electrophysiologist at Subang Jaya Medical Centre (SJMC), breaks down what your heart is trying to tell you—and why ignoring it could increase your risk of stroke.
Dr Louis Chea Chin Yung
Normal Response vs. Warning Sign
Everyone experiences palpitations at some point. Rushing for a bus, climbing stairs, or a intense workout will naturally cause your heart rate to spike. That is a normal physiological response.
The challenge? Arrhythmias (abnormal heart rhythms) are often episodic. Your heart might race at home, but return to normal by the time you reach the hospital, making it invisible on a standard clinic Electrocardiogram (ECG).
To help evaluate your symptoms, Dr. Chea suggests tracking these two main indicators:
Does your heart rate exceed 180 beats per minute (bpm)?
A normal adult resting heart rate is 60 to 80 bpm. While strenuous exercise can push it up to 160 or 180 bpm, abnormal heart rhythms can cause it to surge to 200, 220, or even 230 bpm. Anything over 180 bpm at rest demands medical evaluation.
Is the rhythm irregular?
A fast heart rate can still be regular—beating steadily like a fast drum. More concerning is an irregular rhythm, such as two quick beats followed by a sudden pause, or a pulse that constantly alternates between fast and slow.
🚨 Red Flag Warning: If a rapid or irregular heartbeat is accompanied by chest pain, chest tightness, nausea, dizziness, or a feeling of fainting, do not wait. Head to the nearest emergency department immediately.
Why Are Heart Rhythm Issues on the Rise?
Irregular heartbeats are no longer just an issue for the elderly; clinics are seeing an increasing number of patients in their 20s and 30s. Dr. Chea attributes this rise to three overlapping factors:
- The Surge of Chronic Diseases: Poorly managed hypertension, diabetes, and obesity directly strain the heart. For instance, obesity often leads to sleep apnea, which is a known trigger for irregular heart rhythms.
- The Smartwatch Boom: More people are catching abnormalities early thanks to wearable tech like smartwatches and home blood pressure monitors. Greater health literacy means younger generations are proactively seeking care for themselves and elderly relatives.
- An Ageing Population: The heart naturally ages, making older adults inherently more vulnerable to rhythm disorders.
Young vs. Old: SVT vs. Atrial Fibrillation
Rhythm issues affect different age groups in different ways:
- Ages 20 to 50 (SVT): The most common culprit is Paroxysmal Supraventricular Tachycardia (SVT). This causes the heart to suddenly spike past 180 bpm before abruptly dropping back to normal.
- Older Adults (AF): The primary concern is Atrial Fibrillation (AF), where the risk scales up with age.
Understanding Atrial Fibrillation (AF)
In a healthy heart, electrical signals cause the chambers to contract smoothly. In a patient with AF, the upper chambers (atria) stop contracting effectively. Instead, they quiver chaotically at frequencies of 300 to 600 times per minute.
This disorganization allows blood to pool, increasing the risk of stroke by four to five times compared to the general population.
Diagnosis and Modern Treatment Options
If AF is suspected, a cardiologist will typically use a step-by-step diagnostic approach, starting with non-invasive tests and progressing if necessary:
| Test Type | What It Checks |
|---|---|
| ECG & 24-Hour Holter Monitor | Captures the irregular rhythm during an episode and tracks its duration. |
| Blood Tests | Rules out underlying triggers like thyroid disorders. |
| Echocardiography (Ultrasound) | Assesses heart structure, valve function, and checks for blood clots. |
| Chest X-ray | Checks for heart enlargement or lung complications. |
Managing the Rhythm
The goals of treatment are simple: restore a normal rhythm, control the heart rate, and prevent dangerous blood clots.
Depending on the severity, options include:
- Medication: Anti-arrhythmic drugs to manage the rhythm and anticoagulants (blood thinners) to prevent strokes.
- Catheter Ablation: A highly effective, minimally invasive procedure. A specialist guides a tiny catheter through a vein in the groin up to the heart. The abnormal heart tissue causing the chaotic signals is precisely ablated (destroyed), preventing the erratic rhythm from recurring.
Dr. Chea’s Top 3 "Heart Homework" Tips
Early detection yields significantly higher recovery rates. Protect your heart by adopting these lifestyle habits:
- Manage Modifiable Risks: Keep a close eye on your blood pressure, blood sugar, and weight. Limit alcohol consumption and avoid smoking.
- Focus on the Rhythm, Not Just the Speed: Pay attention to how your heart beats. Consistent irregularity is often a bigger warning sign than temporary speed.
- Get Regular Screenings: Don't wait for a major cardiac event or a stroke to happen. If you have a family history of heart disease, diabetes, or high blood pressure, schedule routine cardiac check-ups.
Your heartbeat is a direct indicator of your health. If something feels off, listen to your body and consult a cardiologist.
This article is adapted from a China Press article. Read the full story in Chinese here: 别因年轻就忽略 读懂心跳异常