Question

Like many people with ME I have occasional palpitations. Does this mean that I might have some form of underlying heart disease? Or is this just another part of having ME? And are there any drug treatments that might be helpful?

Answer

Palpitations are a medical term to describe having an increased awareness of your heartbeat, of it pounding or beating fast. They might be felt in your chest, throat, or neck. It can feel like your heart skipped or stopped beats. These feelings are very common, occur in perfectly healthy people, and in most cases are nothing to worry about.

But palpitations can be a sign of an underlying health problem. In addition to heart disease, they can be caused by anxiety and stress, alcohol, anaemia, having an overactive thyroid gland (thyrotoxicosis), infections, the menopause and taking too many caffeine-containing drinks. A number of drugs can also cause palpitations as a side effect. Common ones include over-the-counter cold remedies, thyroxine and tricyclic antidepressants such as amitriptyline.

In the case of ME/CFS they can be caused by overactivity of what is called the autonomic nervous system – a part of the nervous system with control centres in the brain that send messages to the heart, bladder and bowel to either speed up or slow down activity. Having autonomic nervous system overactivity does not mean that people with ME/CFS have heart disease – the problem lies with overactivity of nerves that control pulse rate and blood pressure, not the heart itself. Palpitations can occur with orthostatic intolerance – which is common in ME/CFS – and in postural orthostic tachycardia syndrome (PoTS) – see links below to additional information.

If you are having palpitations it’s worth speaking to your GP – especially if there is any past history or family history of heart disease or ‘red flag’ symptoms such as chest pains, fainting episodes or shortness of breath. Your GP can take a proper history, examine your heart and do some blood tests to check for anaemia, thyroid function etc. and, if necessary, arrange for an electrocardiogram (ECG) and ambulatory 24-hour heart monitoring to check for abnormal heart rhythms. If there isn’t any obvious medical cause, and palpitations are causing distress, there are a number of drug treatment options, including what are called beta blockers, which can slow down the heart rate. These options can be discussed with your GP.

More information

• The ME Association has detailed information booklets available to download from the website shop:
  • Dr Shepherd and Dr Lisa Dvorjetz (Psychology Adviser to the ME Association) explain what causes anxiety and panic attacks, why we might get anxious, what we can do to help ourselves, and when to seek help from a medical professional.
  • We explain what might be causing loss of balance and dizziness when moving from sitting/lying to standing, and how this can be managed. Orthostatic Intolerance is a symptom that affects most people with ME/CFS to some degree and it is now recognised as a key diagnostic feature.
  • We explain Postural Orthostatic Tachycardia Syndrome (PoTS), how it relates to orthostatic intolerance, why it affects some people with ME/CFS, and how it can be diagnosed and treated.