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Original Research (Original Article) 


Fehaid Alanazi et al, 2020;4(2):383–388.

International Journal of Medicine in Developing Countries

Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia

Fehaid Alanazi1, Khalid Ayidh Alotaibi2*, Fehaid Saleh Almutlaq2, Ahmed Abdulrahman Aldahash2, Abdulaziz Ibrahim Alsenani2

Correspondence to: Khalid Ayidh Alotaibi

*Medical Intern, Majmaah University, Al Majmaah city, Saudi Arabia.

Email: khalidayidh1 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 09 December 2019 | Accepted: 26 December 2019


ABSTRACT

Background:

Palpitations are a sensory symptom and are often described as a skipped beat, rapid fluttering in the chest, pounding sensation in the chest or neck, or a flip-flopping in the chest. Palpitations are nonspecific and can be a symptom or a diagnosis. This study aims to measure the level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia.


Methodology:

The cross-sectional study, distributed among the adult population who were both male and female in Riyadh region, Saudi Arabia. Data were collected by pre-tested questionnaire and analyzed by using Statistical Package for the Social Sciences version 22 to assess the level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia.


Results:

The study included 331 respondents; about 31.1% of them were within the age range of 18–30, 11.5% were less than 18 years, and 93.1% were from Saudi Arabia, while 6.6% were Non-Saudis. For the general awareness, out of 331 respondents, only 70 participants who had experienced any heart palpitations were taking medications. Also, the Chi-Squared test also confirms that there is a significant relationship between medication used and experiencing Palpitations.


Conclusion:

Palpitations due to cardiac origin could be because of any reason, including arrhythmias, valvular heart diseases, cardiomyopathy, and pacemakers. The second most common cause is of psychiatric origins, such as a panic attack, anxiety, depression, and somatization. Overall, there is a need for an increased level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia.


Keywords:

Palpitation, awareness, cardiovascular diseases, Riyadh, Saudi Arabia.


Introduction

Palpitation is one of the most common presenting symptoms to outpatient cardiologist/internists’ clinics, which represents 16 percent out of 500 medical outpatients [1]. Palpitation is defined as a rapid pulsation, an abnormally rapid or irregular beating of the heart. Palpitations are a sensory symptom and are often described as a skipped beat, rapid fluttering in the chest, pounding sensation in the chest or neck, or a flip-flopping in the chest. Palpitations are nonspecific and can be a symptom or a diagnosis [2].

Regarding the prevalence of heart palpitations in Saudi Arabia, 20% participants, out of 257 medical students at Umm Al-Qura University in 2013, experienced palpitations as a side effect of energy drinks consumption [3]. Goyal et al [4] recommended for more awareness companies and clubs to increase the awareness toward palpitations and side effects of energy drinks consumption [4]. Palpitation has a wide extensive differential diagnosis in a study conducted among 190 patients presented to the clinic with chief complain of palpitations. It showed that among the 190 patients, in 84% the cause was determined, the most common cause was cardiac origin (43%), and 31 present were due to psychiatric causes, miscellaneous causes (e.g., medication-induced, thyrotoxicosis, caffeine, cocaine, anemia, amphetamine, mastocytosis) were only 10% [5,6]. Another study was conducted in 2003, among 184 participants who complained of palpitations in the out-patient cardiac clinic, it showed 34% had arrhythmia, and 41% had extrasystoles and also showed awareness of sinus rhythm in 26% [7].

In their study, they (Nymes, Mathiesen, Njolstad, Wilsgaard, & Lochen, 2012) examined the effects of palpitations and cardiovascular risk factors in the prediction of atrial fibrillation (AF). The study involved a massive population-based cohort design and samples of 22,815 study participants were involved. For data analysis purposes, the researchers used a regression model to generate Cox proportional hazards that played a significant role in the estimation of hazard ratios for AF. The results showed that women have high chances of getting AF compared to men. Besides, it was evident that body mass index and height have high risks on AF in men. The study concluded that palpitations, body mass index, and hypertension leads to AF in both men and women.

Palpitations due to cardiac origin could be because of any reason, including arrhythmias, valvular heart diseases, cardiomyopathy, and pacemakers. The second most common cause is of psychiatric origins, such as a panic attack, anxiety, depression, and somatization. Also, other causes can cause palpitations like medications (Sympathomimetics agents, vasodilators, anticholinergics, and beta-blockers withdrawal), cocaine, amphetamines, caffeine consumption, and nicotine. Metabolic disorders can cause palpitations, such as hypoglycemia, thyrotoxicosis, and pheochromocytoma. Anemia, pregnancy, fever, stress, and exercise are the causes of palpitations [5,6].

To determine the cause of the palpitations, a careful history and physical examination should be done. Patients may describe palpitations in a variety of ways, such as a fluttering, pounding, or uncomfortable sensation in the chest or neck, or simply an increased awareness of the heartbeat. History should include age to narrow the differential diagnosis, socio-demographic data, stressors and psychiatric illness screening, drug and energy drinks should be screened also [8].

Physical examination primarily serves to determine if there are cardiac or other abnormalities present that might predispose the patient to palpitations. The physician should look for evidence of hyperthyroidism (e.g., nervousness, heat intolerance), drug use, or other serious illnesses. Finally, in the occasional patient who has palpitations with exercise, the examination of the patient after he or she exercises may reveal an arrhythmia or murmur that is exacerbated by the resulting increased heart rate and cardiac output. 12-lead Echocardiography (ECG) should be done to the patient who complains of palpitations, to exclude cardiac causes. Complete blood count and hormonal studies should be ordered to assess the causes of palpitations. Continue ECG monitoring to record 24–48 hours to assess any cardiac abnormalities during the day [8]. Patients who experience palpitations with exertion should be evaluated with standard exercise stress testing because they are at higher risk of morbidity and mortality. An electro-physiologic study may be warranted in patients with palpitations preceded by syncope or near-syncope, as well as in those in whom there is a high index of suspicion of a cardiac origin not diagnosed with other studies. ECG helps to evaluate the patients for structural heart disease and should be performed when initial history and physical examination are unrevealing, or in patients with a history of cardiac disease or more complex signs and symptoms (e.g., dyspnea, orthopnea, and lower extremity edema) [9].

The management of palpitations is determined by the underlying cause of the symptoms [10]. Radiofrequency ablation can cure most types of supraventricular and many types of ventricular tachycardia [10]. The most challenging cases involve palpitations that are secondary to supraventricular or ventricular ectopy or associated with normal sinus rhythm. These conditions are thought to be benign, and the management involves reassurance of the patient that these arrhythmias are not life threatening. In these situations, when the symptoms are unbearable or incapacitating, treatment with beta-blocking medications could be considered and may provide a protective effect for otherwise healthy individuals [11].

The management of most sustained supraventricular or ventricular arrhythmias causing palpitations involves referral to a specialist trained in the pharmacologic and invasive electrophysiologic management of arrhythmias. Most types of regular supraventricular tachycardias and some types of ventricular tachycardias are now curable with radiofrequency ablation [12]. Patients who present to the emergency department who are asymptomatic, with unremarkable physical examinations, non-diagnostic ECGs and normal laboratory values, can safely be sent home and instructed to follow up with their primary care provider or cardiologist. Patients whose palpitations are associated with syncope, uncontrolled arrhythmias, hemodynamic compromise, or angina should be admitted for further evaluation [2].

The results of this study would enable the healthcare sector to develop effective policies and reforms that would address palpitation and its risk factors, both in the present and in the future. Using the results of this study, scholars would be able to conduct further research and address the existing gaps identified in the research.


Subjects and Methods

This study adopted a cross-sectional design, conducted in Riyadh region, Saudi Arabia, 2019. Riyadh is located at the center of Saudi Arabia and it occupies an area of 404,240 kilometers per square and has a population of approximately 8.2 million people. Riyadh region is known to be the capital city of Saudi Arabia. The study distributed among the adult population who were both male and female in Riyadh region, Saudi Arabia. The study adopted a census approach as a sampling technique based on the assumption that all adult males and females were agreed to answer the questionnaire in this study. The study included 382 participants. Pre-tested, electronic questionnaires were used in data collection. The questionnaire included questions about socio-demographic factors, awareness of palpitations among the adult population in the Central Region, Saudi Arabia.

Once the data had been collected, it was important to analyze it with the purpose and objectives of the study and as a result, generate meaning results, conclusion, and recommendations of the study. In data analysis, there were various steps involved, which included data cleaning, data coding, and data aggregating. This study analyzed the collected data using Statistical Package for the Social Sciences version 22, whereby descriptive statistics, bivariate statistics, and numerical analysis were generated.

Ethical consideration in the case of this study, the researcher ensured that the data gathered from the respondents would only be used for this study and in case of misleading information; the researcher would undertake an ethical procedure to solve the problem. Besides, the researcher would be responsible for protecting the confidentiality of the respondents. The information gathered would adhere to the benefits and the intended purposes of the study. To provide an accurate and fair view of the study, the study seeks the anonymity of the participants and this enhanced privacy and confidentiality of the study’ participants.


Results

Table 1 is the socio-demographic data of the respondents, from the Table 1, 11.5% of the respondents were less than 18. Majority of the respondents were more than 50 years of age. Most of the populations were female (55%), while 44.7% were males. Most of the participants lived in Sudiar; majority was married (50.8%), while only a few (2.1%) were divorced.

Table 2 displays the general awareness of the respondents regarding Palpitations. Among the participants, 45% believe that all the listed associated symptoms of palpitation make them go to the ER. However, 10.6% believe that chest pain make them go to the ER. Moreover, 63.7% thinks there is a relationship between palpitations and caffeine consumption. To define Palpitation, 78.9% says it is the noticeably abnormal rapid or irregular beating of the heart.

From the cross-tabulation Table 3, the number of persons who had experienced any heart Palpitations and currently taking medications were 70; however, 106 of the participants had not experienced Palpitations, hence were not taking any medications.

Table 4 is a Chi-Squared test to see the relationship between medication used and experiencing palpitation. Since the p-value is 0.000, which is less than 0.05, hence, we concluded that there is a relationship between medication used and experiencing palpitation.

Table 1. Socio-demographic data analysis.

Frequency Percent
Age Less than 18 38 11.5
18–30 103 31.1
31–40 93 28.1
41–50 60 18.1
More than 50 36 10.9
Gender Male 148 44.7
Female 182 55.0
Residency Riyadh 88 26.6
Others 46 13.9
Qassim 42 12.7
Sudair 154 46.5
Nationality Saudi 308 93.1
Non-Saudi 22 6.6
Marital status Single 149 45.0
Married 168 50.8
Widowed 6 1.8
Divorced 7 2.1
Level of education Primary 8 2.4
Secondary 109 32.9
Bachelor 138 41.7
Intermediate 15 4.5
Other 30 9.1
Postgraduate studies 30 9.1
Occupation Employed 162 48.9
Unemployed 168 50.8

Table 5 is a cross-tabulation of participants experiencing any heart Palpitations with some health problems. From Table 5, it is observed that 16 participants were experiencing Diabetes Mellitus alongside with Hypertension, 10 were suffering from Thyroid diseases, 12 from pulmonary diseases. However, six persons were suffering from Diabetes Mellitus alongside with Hypertension but they don’t even know if they were experiencing heart Palpitation.

Table 6 is a Chi-Squared test to ascertain the relationship between participants experiencing any heart Palpitations with some health problems. It is seen that the p-value is 0.000, which is less than 0.05; hence, we conclude that there is a significant relationship between health problems and experiencing palpitation.


Discussion

The purpose of this study was to ascertain the awareness of palpitations among the adult population in Riyadh Region, Saudi Arabia. Specifically, to assess the level of awareness of the general population in the Riyadh region of Saudi Arabia toward Palpitation, and also to assess the relationship between the level of awareness and socio-demographic data. The socio-demographic data shows that a high percentage of the respondents were more than 50 years of age as just 11.5% of the respondents were less than 18. Most of the participants were female (55%), while 44.7% were males. Most of the participants lived in Sudiar; majority (50.8%) was married, while only a few (2.1%) were divorced. Among the participants, 16.3% work in the health field, while 32.6% do not. Most of the respondents had an income level less than 3,000. Among the participants, 39% happened to be on medication, and 6.9% of them were on Ventolin medication, while 47.7% were on other medication. A study conducted by Hafiz Muhammad Aslam, Anum Mughal, Muhammad Muzzammil Edhi, on the topic that assesses the pattern for consumption and awareness regarding energy drinks among medical students showed that most common side effects reported by users were fatigue (111) (31.7%) and weight gain (102) (29.4%), and out of the 350 energy drink users, 36.6% of them believe that energy drinks cause palpitations, hypertension and heart problems. Hence, this warrants the creation of continued public health awareness about the appropriate use of caffeinated beverages, their potential benefits, side effects, and correction of wrong perceptions [12]. The relationship between Palpitation and Mental Health was a research conducted by Fatemeh Alijaniha, Ahmadali Noorbala, Suleiman Afsharypuor, Mohsen Naseri, Faramarz Fallahi, Mahmood Mosaddegh, Soghrat Faghih Zadeh, and Sima Sadrai, aimed to screen for mental disorders in patients complaining of palpitation and healthy persons to perform a preliminary comparison between them. This is a case-control study to screen mental disorders. The target population consisted of adult volunteers with benign palpitation and their matched healthy persons. Comparing two groups showed that the number of participants with the scores more than a cut-off point in palpitation group was significantly more than healthy person group (85.4% vs. 43.6% with p < 0.001). According to the results of the study, palpitation was the most common symptom in psychiatric disorders, such as anxiety and somatization disorders. Psychiatric causes have an important role in Iranian patients complaining of palpitations; considering this fact may lead to more effective treatment of benign palpitations [13,14].

Table 2. General public awareness.

General Awareness Levels Frequency Valid Percent
Work in health field Yes 54 16.3
No 108 32.6
Income level Less than 3,000 125
3,000–5,000 49 66.3
5,000–10,000 72 33.7
10,000–15,000 48
More than 15,000 36
Are you taking any medications now? Yes 129 39.0
No 201 60.7
In case you answered the previous question with Yes, please answer this question. Thyroxine 21 6.3
Ventolin 23 6.9
Other 158 47.7
What is the definition of palpitation? Noticeably abnormal rapid or irregular beating of the heart. 261 78.9
Decrease in the heart rate. 13 3.9
Stopping the heartbeat. 5 1.5
I don’t know 51 15.4
Have you ever experienced any Heart palpitations? Yes 159 48.0
No 153 46.2
I don’t know 18 5.4
Do you think there is a relationship between palpitations and caffeine consumption? Yes 211 63.7
No 20 6.0
I don’t know 99 29.9
Shortness of breath 32 9.7
Which of the following associated symptoms with palpitation makes you go the ER? Chest pain 35 10.6
Drowsiness 15 4.5
Loss of consciousness 19 5.7
All of above 150 45.3
I don’t know 79 23.9

Table 3.

Are you taking any medications now? * Have you ever experienced any Heart Palpitations? Cross tabulation Count
Have you ever experienced any Heart Palpitations? Total
Yes No I don’t know
Are you taking any medications now? Yes 70 47 12 129
No 89 106 6 201
Total 159 153 18 331

Table 4.

Chi-Square Tests
Value df Asymptotic Significance (2-sided)
Pearson Chi-Square 342.914a 6 .000
Likelihood Ratio 25.432 6 .000
N of Valid Cases 331

a6 cells (50.0%) have expected count less than 5. The minimum expected count is 0.00.

Table 5.

Do you suffer from any of the following health problems: (you can choose more than one) * Have you ever experienced any Heart Palpitations? Cross tabulation
Count
Have you ever experienced any Heart Palpitations? Total
Yes No I don’t know
Do you suffer from any of the following health problems: (you can choose more than one ) AQ 1 0 0 0 1
None 0 86 102 8 196
Psychiatric diseases 0 8 3 2 13
Pulmonary diseases 0 12 4 0 16
Pulmonary diseases; Psychiatric diseases 0 3 1 1 5
Thyroid diseases 0 10 7 1 18
Cardiovascular disease; Diabetes Mellitus; Hypertension 0 3 1 0 4
Cardiovascular disease; Pulmonary diseases; Diabetes Mellitus; Hypertension 0 6 0 0 6
Cardiovascular disease 0 4 2 0 6
Cardiovascular disease; Thyroid diseases; Diabetes Mellitus; Hypertension 0 6 0 0 6
Diabetes Mellitus 0 3 7 0 10
Diabetes Mellitus; Hypertension 0 16 23 6 45
Hypertension 0 2 3 0 5
Total 1 159 153 18 331

Table 6.

Chi-Square Tests
Value df Asymptotic Significance (2-sided)
Pearson Chi-Square 371.253a 36 .000
Likelihood Ratio 58.079 36 .011
N of Valid Cases 331
a41 cells (78.8%) have expected count less than 5. The minimum expected count is .00.

Conclusion

Palpitations due to cardiac origin could be because of any reason, including arrhythmias, valvular heart diseases, cardiomyopathy, and pacemakers. The second most common cause is of psychiatric origins, like a panic attack, anxiety, depression, and somatization. Overall, there is a need for an increased level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia.


List of Abbreviations

AF Atrial fibrillation
HR Hazard ratios

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was conducted after the approval of Ethics Committee at Majmaah University (NOV.19/COM-2019/9).


Author details

Fehaid Alanazi1, Khalid Ayidh Alotaibi2, Fehaid Saleh Almutlaq2, Ahmed Abdulrahman Aldahash2, Abdulaziz Ibrahim Alsenani2

  1. Head of Internal Medicine Department, Majmaah University, Al Majmaah, Saudi Arabia
  2. Medical Intern, Majmaah University, Al Majmaah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alanazi F, Alotaibi KA, Almutlaq FS, Aldahash AA, Alsenani AI. Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. IJMDC. 2020; 4(2): 383-388. doi:10.24911/IJMDC.51-1575930917


Web Style

Alanazi F, Alotaibi KA, Almutlaq FS, Aldahash AA, Alsenani AI. Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. https://www.ijmdc.com/?mno=77352 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575930917


AMA (American Medical Association) Style

Alanazi F, Alotaibi KA, Almutlaq FS, Aldahash AA, Alsenani AI. Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. IJMDC. 2020; 4(2): 383-388. doi:10.24911/IJMDC.51-1575930917



Vancouver/ICMJE Style

Alanazi F, Alotaibi KA, Almutlaq FS, Aldahash AA, Alsenani AI. Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. IJMDC. (2020), [cited October 15, 2021]; 4(2): 383-388. doi:10.24911/IJMDC.51-1575930917



Harvard Style

Alanazi, F., Alotaibi, . K. A., Almutlaq, . F. S., Aldahash, . A. A. & Alsenani, . A. I. (2020) Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. IJMDC, 4 (2), 383-388. doi:10.24911/IJMDC.51-1575930917



Turabian Style

Alanazi, Fehaid, Khalid Ayidh Alotaibi, Fehaid Saleh Almutlaq, Ahmed Abdulrahman Aldahash, and Abdulaziz Ibrahim Alsenani. 2020. Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (2), 383-388. doi:10.24911/IJMDC.51-1575930917



Chicago Style

Alanazi, Fehaid, Khalid Ayidh Alotaibi, Fehaid Saleh Almutlaq, Ahmed Abdulrahman Aldahash, and Abdulaziz Ibrahim Alsenani. "Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 383-388. doi:10.24911/IJMDC.51-1575930917



MLA (The Modern Language Association) Style

Alanazi, Fehaid, Khalid Ayidh Alotaibi, Fehaid Saleh Almutlaq, Ahmed Abdulrahman Aldahash, and Abdulaziz Ibrahim Alsenani. "Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia." International Journal of Medicine in Developing Countries 4.2 (2020), 383-388. Print. doi:10.24911/IJMDC.51-1575930917



APA (American Psychological Association) Style

Alanazi, F., Alotaibi, . K. A., Almutlaq, . F. S., Aldahash, . A. A. & Alsenani, . A. I. (2020) Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (2), 383-388. doi:10.24911/IJMDC.51-1575930917