Why am i aware of my heartbeat

When to Evaluate Heart Palpitations

Featured Expert:

Palpitations are symptoms of everything from short or long-term stress to a variety of arrhythmias (irregular heartbeats). They may feel alarming, but do not always reflect a serious heart condition. Joseph Marine, M.D., vice-director of the Division of Cardiology at Johns Hopkins, starts his evaluation by asking his patients what they hear.

What are palpitations?

Palpitations are characterized as a general or heightened awareness of your own heartbeat – whether it’s too fast, too slow, or otherwise irregular. You might feel like your heart is thumping, racing, or fluttering. And you could feel this sensation in your chest or your neck.

“I ask them to tap out what their heartbeat feels like. Then I get a sense of whether we’re dealing with isolated skipped beats or a more sustained arrhythmia,” says Marine. “Patients frequently will feel their skipped beats more at night, when they’re lying in bed and nothing is distracting them from it.”

Diagnosing palpitations

Palpitations can occur for a variety of reasons unrelated to heart disease. These include:

Overexertion
Stress
Caffeine, alcohol, tobacco, or diet pills
Overactive thyroid
Hormone changes associated with menstruation, pregnancy, or menopause
Low blood pressure
Heart disease or abnormal heart valves
The body’s response to medications such as thyroid pills, cold medicines, and asthma drugs

Palpitations can also result from a range of heart arrhythmias. These are classified by location, and type of heartbeat. A few common types:

Supraventricular tachycardia – A rapid heart rate originating above the ventricles (lower heart chambers). It can cause the heart to beat very quickly or erratically. Symptoms might include an overly fast pulse and dizziness.
Atrial fibrillation – The most common type of arrhythmia, an atrial fibrillation can result in a rapid and erratic heartbeat, which may interfere with blood flow to the ventricles and possibly lead to serious clotting conditions or stroke. Symptoms might not exist at all, or involve chest pain, palpitations, or shortness of breath.
Ventricular tachycardia – A rapid heartbeat originating in the ventricles (lower heart chambers). When associated with structural heart disease, this arrhythmia may cause loss of consciousness and, in some cases, cardiac arrest or sudden death.

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Separating serious palpitations from harmless ones

It’s important to differentiate palpitations caused by stress or minor arrhythmias from those that may point to an underlying heart disease. Inconveniently, palpitations don’t always occur during the time you’re with your doctor.

Marine recommends coordinating an electrocardiogram (ECG) with the irregular heart beat symptoms the patient is having by using a Holter or event monitor.

A Holter monitor is a portable machine you would carry in your pocket or small pouch around your neck or waist for 24 to 48 hours. Electrodes connect your chest to the monitor wires to record your heart rhythms.

An event monitor records heart rhythms for a longer span of time (about a month). The patient activates the monitor whenever he or she experiences an irregular heartbeat.

Treating palpitations

Depending on the severity of the symptoms and underlying cause of the palpitation, your doctor will typically recommend one of three treatment options:

Preventive care (for non-severe palpitations) – Try eliminating smoking, excess caffeine, and alcohol from your daily regimen; practice general deep breathing and yoga; get plenty of sleep and exercise; regularly schedule “you” time.
Medications – Your physician might prescribe antiarrhythmic drugs such as beta blockers and calcium channel blockers, both of which have a safe track record. Occasionally these drugs don’t work effectively and stronger antiarrhythmic drugs that directly act on the sodium and potassium channels of the heart might be necessary.
Catheter ablation – Small wires are threaded through the leg veins into the heart to trigger an arrhythmia, identify the cause, and cauterize the problem area. This treatment is highly effective when the physician can identify an arrhythmia in a specific region of the heart (such as supraventricular tachycardia).

Other outpatient procedures include cardioversion (electric shock sent to the chest wall to synchronize the heartbeat to a normal rhythm), and an implantable defibrillator (a special type of pacemaker that automatically detects and terminates ventricular arrhythmias associated with heart disease).

Sometimes comfort and reassurance are the best medicine

“While palpitations can sometimes signal a more serious condition, they’re often just a sensation of a normal heartbeat,” says Marine. “Confirming that nothing is seriously wrong is sometimes all a person needs. Relaxation techniques and reassurance from a physician – I find that both are very helpful when the cause of palpitations is benign.”

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Is It Natural to Be Aware of Your Heartbeat? I Psych Central

Heart palpitations are usually harmless and go away on their own. But they could also be a sign that you’re living with anxiety.

If you’ve ever suddenly become aware of your heartbeat, you’re not alone. It’s a common complaint healthcare professionals hear from their patients.

The sensation of being aware of your heartbeat is called heart palpitations. It may feel like your heart is beating fast, fluttering, or skipping a beat.

While it can be worrying and unpleasant, heart palpitations can be harmless in some cases and eventually go away. But heart palpitations can also signify a more serious underlying heart condition.

According to the American Heart Association (AHA), your heart beats around 100,000 times a day, but you don’t notice it most of the time.

A 2016 study suggests this may be because your brain blocks out the sensation of your heart beating so that it can focus on other senses such as sight, sound, and touch.

But when your heart begins beating abnormally, your brain starts to pick up on that, and you eventually become aware of it. This uncomfortable awareness of your heartbeat is known as heart palpitations.

You may feel your pulse in your neck, throat, or chest with heart palpitations. It can feel like your heart is:

racing, pounding or beating fast
skipping or adding extra beats
fluttering
flip-flopping

Heart palpitations usually last a few seconds to minutes. But they can last longer in some cases.

It’s also possible to become aware of your heartbeat by simply paying close attention to it. But this doesn’t qualify as palpitations.

According to research from 2022, some of the most common causes of heart palpitations are:

stress
too much exercise
certain drugs (alcohol, nicotine, and caffeine) and medications
health conditions such as anemia and hyperthyroidism
excessive sweating due to loss of electrolytes

The cause of heart palpitations is unknown for about 30% of cases, according to research from 2017. Palpitations may also be due to an underlying heart condition such as an irregular heartbeat (arrhythmia) or a heart defect.

Anxiety can also lead to palpitations, especially if it’s marked by hypervigilance — a state of heightened alertness and sensitivity to your surroundings. It develops as a way for the body to protect itself from threats.

When you’re hypervigilant, you may constantly look for any possible danger in your environment. This could cause you to perceive threats that aren’t real or overreact to minor threats. An example may be jumping at a loud noise or sudden movement.

Hypervigilance affects people who may have:

post-traumatic stress disorder (PTSD)
schizophrenia
anxiety disorders
depression

Heart palpitations are one of many symptoms you may experience if you have anxiety. Other symptoms that may occur alongside palpitations include:

excessive sweating
stomach pain
headaches and dizziness
fatigue

Hypervigilant states can produce similar symptoms, including sweating, fast heart rate, and fatigue. These symptoms may worsen when you’re in a new or unfamiliar environment or around strange people. These types of situations can often trigger heart palpitations.

You may also experience emotional symptoms such as fear, panic attacks, and feeling tense.

While heart palpitations are harmless in most cases, consider reaching out to a healthcare or mental health professional if:

they occur suddenly with no identifiable trigger
you have heart disease or risk factors for heart disease
they won’t go away and keep getting worse
they last longer than a couple of minutes
you have a history of heart disease in your family

Emergency medical attention is required if you have heart palpitations in addition to:

chest pain
feeling faint
shortness of breath

Heart palpitations often go away on their own without treatment. But you can take steps to reduce the chance of experiencing them or to help manage them.

Mindfulness meditation

Mindfulness meditation is the act of observing your thoughts and the present moment as it unfolds without judging or reacting to them.

This type of meditation has been shown to lower levels of the adrenocorticotropic hormone (ACTH), a hormone involved in the stress response, according to a 2018 study.

Cut out stimulants

Try to cut out or reduce how much caffeine you’re consuming. Caffeine can raise cortisol levels, according to research from 2006. This can make you feel more anxious.

Nicotine also acts as a stimulant, so try to reduce or eliminate your intake.

Some medications may cause an irregular heartbeat. Consider talking with a healthcare or mental health professional about any medications you’re taking and their possible side effects.

Deep breathing

Deep breathing is the act of consciously taking slow, deep breaths — inhaling slowly through the nose and exhaling through the mouth.

A 2017 study suggests that breathing deep into your diaphragm may help reduce anxiety and cortisol levels. It can also help slow a racing or pounding heart.

Light exercise

A 2018 review suggests that exercise in general, from light exercise such as going for a walk to more intense exercise, may help reduce anxiety.

Exercising can also help take your mind off any irregular heartbeats.

Get good sleep

Lack of sleep can make you less able to handle stress and more likely to experience heart palpitations. You can get optimal sleep by following a consistent sleep schedule and avoiding electronic devices at night.

Get help

Controlling anxiety can be difficult by yourself. But talking with a close friend or family member about your anxiety may help.

If your anxiety is interfering with your daily life, consider reaching out to a mental health professional. They can help you manage your symptoms and recommend treatment if needed.

How common is it to have heart palpitations with anxiety?

Heart palpitations are a common physical symptom of anxiety.

In fact, it’s one of the diagnostic criteria for generalized anxiety disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

Hypervigilance is also a common feature of anxiety disorders.

Who’s at risk?

You’re more likely to experience heart palpitations if you:

are older
have severe anxiety and panic attacks
are pregnant
have an overactive thyroid gland
have other heart problems

Heart palpitations occur when you become aware of your heart beating strangely.

While palpitations can sometimes indicate a medical problem, such as a heart issue or low blood count, they’re often harmless and may go away after some time.

Reducing your stress levels, deep breathing, getting enough sleep, and avoiding stimulants can help reduce the chance of getting palpitations and manage them when they happen.

If your palpitations are bothersome or unexplained, evaluation by a healthcare professional is recommended. If they’re accompanied by shortness of breath or chest pain, call 911.

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“It’s like I don’t exist”: what is depersonalization

This happened to me

“It’s like I’m not there”: what is depersonalization

Dima Kozachenko

January 19, 2017 12:27

Violation of the perception of one’s own “I” , a feeling of unreality of what is happening, anxiety attacks, panic attacks and loss of emotions - these are the symptoms of depersonalization disorder, which is often confused with schizophrenia. Afisha Daily publishes three stories of people with this terrible diagnosis.

Tatyana, 28 years old: “For the first time, I encountered a feeling of unreality of what was happening when I was 22 years old. One day, I just stopped feeling any emotions; my relatives suddenly became strangers, I didn’t want to communicate with anyone, go out anywhere. I didn’t feel like myself - the personality was erased, and I became a different person: the feeling that there was no more soul, only one shell. This was accompanied by constant anxiety, soul-searching, headaches, and a sense of hopelessness. This is a terrible state when suicide seems to be the only way to stop everything.

I was very frightened and urgently called my mother, because I myself could not even go to the doctor. The neurologist at the hospital said that I was depressed and prescribed a cocktail of antidepressants and neuroleptics. Surprisingly, almost from the first days of taking the pills, I returned to life: the symptoms disappeared, my mood improved, my ability to work increased, I became sociable and open. A month later, I stopped taking these drugs and did not go to the doctor again (although I was warned not to give up the drugs). For four years, I forgot about the problems.

The symptoms returned when a relative offered me a new job. There were rather high requirements for employees - a mandatory driver's license, specialized education in the field of shipping and fluent English. I was given six months to prepare. The relative paid for all the courses, the university - and then the stress began. I felt that it was covering me, so I arbitrarily returned to the pills. It got a little easier for a while. I tried my last strength not to lose face, to get this job, not to let down the person who believed in me and also spent money. But I got worse and worse, and I failed the job interview. It was a very difficult period.

After that, I began to sit on forums, google articles about mental disorders with similar symptoms. There were thoughts that I had schizophrenia and I was finally going crazy. I started running around psychiatrists, but all of them refuted my suspicions. Depression was re-diagnosed, antidepressants were prescribed - anxiety subsided a little, but emotions and feelings never returned.

Once on some website I saw a description of a diagnosis that exactly matched my symptoms. Then my acquaintance with depersonalization-derealization disorder began. I went to doctors, but they basically didn't know what it was and how to treat it. Sometimes they simply did not want to listen to me - they immediately prescribed medicines and sent me home. One professor said that I "read on the Internet." I found my salvation in online consultations with a doctor who dealt with dereal: according to his scheme, I started taking antidepressants and antiepileptic drugs.

The reason for my depersonalization is neurosis, which is accompanied by anxiety: under stress, the body defends itself and the brain seems to turn off, isolation from the outside world occurs. This happens to impressionable people who worry about anything, take everything to heart. I am one of those.

My experience is 2.5 years. I know that there may be deterioration, but there is a way out. Now I have reached the stage when a new job is a joy, I feel like myself again, mental abilities, emotions and feelings are the same as before the illness. And, although I'm still on the pills, it's better than suffering again. I hope someday I can cancel them. It sounds strange, but this illness has changed me for the better. Thanks to her, I truly began to appreciate life and loved ones. Became more patient. I am glad that I can live a normal life again, feel, love, enjoy communication with people and from my favorite activities.

Our society is very contemptuous of those in need of psychological help. If they find out that a person has been to a psychiatrist, they immediately label him a psycho and avoid him. Nevertheless, you should not be afraid to seek qualified help, the main thing in this matter is to find a really good doctor. And there are very few of them. "

Nikolai, 27 years old: “I have been neurotic since childhood: stuttering, obsessive-compulsive disorder (obsessive thoughts syndrome). In August 2014, I went to a psychiatrist with depression and impaired perception of reality, I was then 25 years old. It all started with rare panic attacks, which were replaced by bouts of severe derealization. The world turned upside down, and I had to lie down on the floor and close my eyes, this helped to come to my senses. After another such attack, I developed anxiety.

Exactly 6 months I thrashed around looking for and inventing physical illnesses to justify my condition. Admitting to yourself that you are a little "cuckoo" is difficult, and this is how hypochondria appears. The catalyst for hypochondria is still such an unpleasant reality as unskilled medicine. The inertia coming from the USSR still persists - doctors sculpt a diagnosis of VVD (which has long been absent from the world classification of diseases), say that everything is in order, prescribe vitamins and send them home. Therefore, I had to engage in self-diagnosis and be terribly afraid of what was really happening to me. Unfortunately, I made the diagnosis of "depersonalization disorder" myself, once again surfing the Internet. Through acquaintances, I managed to go to a psycho-neurological dispensary. There I was pumped with the same Soviet drugs, put on droppers, there was even a massage and a circular shower. At discharge, there were no significant results: it became easier to sleep, but the condition remained the same painful.

At last, miraculously, I managed to get to a good psychiatrist. Properly selected drugs have built a solid foundation for my recovery. Now pharmacology has reached such a level that drugs work reliably with a minimum of side effects and consequences for the body. Of course, they do not eliminate psychological problems, but they provide a runway for climbing to the height where these problems could be eliminated. The antidepressant began to noticeably act somewhere in 3-4 weeks after the start of the reception. The mood improved, strength appeared, life began to bring pleasure. Then slowly: communication with friends began to recover, I began to go out, my libido and the desire to do something woke up. I recovered at work: when getting to the toilet is a huge test, work becomes something unbearable.

Depersonalization is, in the usual sense, the loss of oneself; when you can't understand what kind of person you are. Recovery after this leads to a rethinking of life attitudes. For example, in the past, I limited myself, tried to conform to the ideas dictated by society. He lived according to the principle “as it should be”, and not “as I want”. During this period, the understanding of one's person is lost: who are you? why are you? who are you supposed to be? You are depersonalizing. At the turning point of frustration, you understand that you need to live for yourself, and not for others, you stop constantly looking for flaws and correcting them in order to become someone. I accepted myself. "

Anastasia, 20 years old: “At school, I was often bullied because of my excess weight, no one took me seriously at home, there were constant screams and scandals because of my father’s alcohol addiction. At the age of 15, I decided to try drugs and, not knowing the “correct dosages”, I took too much at one time. After that, my health deteriorated sharply: short-term panic attacks began, heart palpitations, unsteadiness of gait, dizziness appeared. At first I thought that I had something with my heart or blood vessels; over time, this developed into a fear of a heart attack, stroke, or sudden death. Then there was an examination of the whole body, but nothing concrete was found out: the doctors either did not find anything, or made a diagnosis of "vegetovascular dystonia". One doctor advised me to get tested for cancer.

Over time, the situation progressed. There was a terrible feeling inside, like anxiety: I couldn’t sleep normally, it seemed that I would die any minute. One day I realized that I did not feel my body. There was a feeling of lightness and weightlessness at the same time, and then I began to catch myself thinking that it was as if I were not there. The sensations in my hands became not mine, the reflection in the mirror was not the same. Then I realized that I was in danger not of a heart attack, but of schizophrenia. I completely surrendered to this fear: the physical symptoms disappeared, there was an indescribable horror that now I would lose touch with reality and control over myself. I began to hide the handle from the balcony so that in a fit of unconsciousness the window would not suddenly jump out. The world as I knew it was shattered. Going out into the street, I understood that there was a big barrier between me and reality. The world behind the glass seemed flat, colorless, dead. I couldn't figure out if this was a dream or reality, or maybe I had died altogether. Time just stopped, it didn't exist, it didn't exist for me. And in the soul there is emptiness, silence and no emotions.

I found out that this is not schizophrenia on a site about dissociative disorder. Thus began a new phase. On VKontakte, I found a group about dereal, where there were hundreds of people like me. For about a week I sat in the community, reading information, personal stories and recommendations, until I fully understood that this was it - depersonalization-derealization disorder.

In the 11th grade, everything got to the point that I was taken from the exam in an ambulance. When I went to the doctor, he started asking something, and I was silent: I was so tired of this shit that I could not say a word. My parents found out that I have serious mental problems. It seemed to me that my mother did not understand me. I was again taken to the doctors, but we failed to find an intelligent specialist. In Soviet-era hospitals, doctors are not at all familiar with depersonalization: in one of these, I was prescribed 12 dubious pills a day, and glycine was also completely useless for my symptoms. There were doctors who were more interested in my outlook on life than my health.

As a result, I found my psychiatrist, with whom we still keep in touch, through my mother's friend. If we talk about treatment, then you can’t do without antidepressants. They help to return to the previous mode and significantly improve the condition. Now I'm 20, and I'm still on pills: I decided that it's better to feel good with them than to think about suicide every day.

“The basis of the depersonalization-derealization syndrome is an attempt of the psyche to adapt to stress in conditions of its high intensity, for example, during fear or panic. This syndrome as a separate disorder is included in the international classification of diseases (ICD-10), but often occurs as a secondary syndrome with severe anxiety, depression and other acute conditions. Depersonalization and derealization, although combined into one term due to their similarity and general nature, represent two independent symptoms that can manifest themselves separately from each other. During depersonalization, the patient's own face, figure, smile, speech seem unfamiliar, as if you are watching yourself as an outsider. Derealization, on the other hand, concerns the perception of the environment: place, time, circumstances, etc. Sometimes a feeling of “drunkenness”, “unreality” and “floating picture” is added.

The main cause of DP/DR lies in the activation of opiate receptors - there is an assumption that in this way the human body tries to reduce severe anxiety. Stress can become a reason if it was intense and caused a vegetative crisis (like a panic attack).

Feelings during depersonalization-derealization frighten with their unusualness. It seems to the patient that he has lost control of his own body, and this in itself provokes even more intense fear. It differs from schizophrenia primarily in the absence of symptoms of psychosis (hallucinations, delusions, catatonia, etc.). Also, the DP / DR syndrome can be observed in acute psychotic episodes, but then there must be appropriate mandatory symptoms of a severe mental illness.

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