Day and Night Pharmacy – Palpitations



I’d steal a glimpse of her on the school bus, my heart would flutter. If I ever got in close proximity to her my heart would send rapid pulsating  tremors to my body- a pounding in the neck, twitching fingers and shortness of breath. Lust or love? I don’t know.

I know that palpitations induced by a lustful teenage brain are nothing to worry about.
However the symptoms described above, including a feeling of impending doom, can indicate a major underlying cause like anxiety and panic disorder, an overactive thyroid gland or disorders originating from the heart itself and the blood vessels.

Palpitations can also be a result of conditions like asthma, COPD or low blood volume in which case the heart will be trying to run faster to compensate for the associated lower oxygen supply to the muscles. Some patients then panic racing the heart even faster… A fast heart pumps lower volumes and drains blood from the lungs slowly, causing congestion and a feeling of drowning with the lungs picking up even less oxygen.


Interestingly, a patient on salbutamol for asthma approached me the other day. She thought her inhaler had not been working so she’d taken a lot of puffs to no avail. She was nervous, her heart was racing she thought she was going to have an asthma attack… Salbutamol opens up the airways but races the heart at high doses. She was experiencing side effects and had got herself into a vicious cycle. Got it? You don’t have to. Suffice to say, several medicinal and recreational drugs can precipitate palpitations; antidepressants, caffeine, cocaine and over-the-counter nasal decongestants, etc etc.

Atrial fibrilation (AF) is the rapid and irregular heart rhythm caused by mad electrical wiring of the upper chambers of the heart- this may also present as palpitations. The normal rhythm which would otherwise be in synchrony with the lower chambers is lost. Therefore pumping out of blood to the lungs and the rest of the body is shallow, rapid and irregular. Such stop-start of flow gets the clotting factors in the blood to think, ‘Hey, there must be some injury here, let’s form a clot or two’. This is why AF is linked to clots which result in strokes, heart attacks or deep vein thrombosis (clots). The patients tend to be prescribed prophylactic blood thinners like aspirin, clopidogrel, warfarin or apixaban to name but a few.

The treatment of palpitations is mainly aimed at solving the cause of it. It could be electrical cardioversion to shock the heart back into normal rhythm, removing an overthyroid gland, drugs to slow down heart rate or (as in my case) marrying the attractive girl.

Twenty-one years on, although she frequently raises my BP, roses remain red and violets are still blue. But both are seasonal, both wilt. Yet my heart is in everlasting bloom.
I’ve checked: There’s no expiry date on our marriage certificate.

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