Palpitations in Ajax: How Heart Rhythm Testing Works

What does it actually mean when your heart “skips”? Most people who notice palpitations describe them in very physical, very personal terms. One person feels a thud, as if the heart missed a step and then caught up too hard. Another feels a flutter, like a moth trapped in the chest. Someone else notices a racing beat that starts suddenly while they are sitting still, or a heavy pounding they can feel in the throat when they lie down at night.

The word “palpitations” simply means being aware of your own heartbeat in a way that feels unusual. It is a description of an experience, not a diagnosis. Many palpitations turn out to have harmless explanations, and some point to a rhythm that a provider will want to understand more closely. Telling those apart is the job of your health-care provider, and heart rhythm testing is one of the main tools they use to do it.

This article explains how that testing works from the patient’s side: why a short test is sometimes enough and sometimes not, how longer monitoring fits in, and what you can do to help the recording answer the question your provider is asking. It is written for patients across Ajax, Pickering and Whitby who are seeing their provider about palpitations, or who have already been handed a requisition.

First, the situations that cannot wait

Before anything else, it is important to separate palpitations that can be discussed at a regular appointment from those that need help right now.

Call 911 or go to the nearest emergency department if a racing, pounding or irregular heartbeat comes with chest pain or pressure, fainting or nearly fainting, severe shortness of breath, confusion, or signs of a stroke such as facial drooping, arm weakness or slurred speech. Do the same if a very fast heartbeat will not settle and you feel unwell. Do not drive yourself.

A community diagnostic clinic, including ours, is not an emergency service. Rhythm testing is arranged by appointment to investigate symptoms over time. It is not the right place to go when you feel acutely unwell, and wearing a monitor does not alert anyone if something goes wrong.

If your palpitations are new, frequent, or worrying you but you feel otherwise well, contact your family doctor or nurse practitioner. They can decide how soon you should be seen and which tests make sense.

The heartbeat has its own wiring

To understand rhythm testing, it helps to picture the heart as a pump with a built-in electrical system. A small cluster of cells near the top of the heart acts as a natural pacemaker, sending out a regular signal. That signal spreads through the upper chambers, pauses briefly at a relay point, then travels down specialised pathways into the lower chambers, which contract and push blood out to the body.

When this sequence runs smoothly, you usually do not notice it at all. Palpitations tend to happen when something changes in the pattern:

• An early beat. A signal fires slightly ahead of schedule from somewhere other than the usual starting point. The pause that follows, and the stronger beat after it, is often what people feel as a “skip” or a “thump.”
• A faster rate. The heart speeds up, either appropriately (exercise, fever, anxiety) or because a signal is looping or firing rapidly when it should not.
• An irregular rhythm. Beats arrive at uneven intervals, so the pulse feels chaotic rather than steady.
• Simply noticing a normal rhythm. Lying on your left side, being very still in a quiet room, or feeling anxious can make an entirely normal heartbeat feel loud.

Rhythm tests work by recording that electrical activity through sensors on the skin. They do not take pictures of the heart’s structure; they show the timing and pattern of the signals. That is why they are the natural first step when the question is “what is my heart’s rhythm doing?”

Common everyday contributors

Many things in ordinary life can make the heart beat faster or produce extra beats. Your provider will likely ask about some of these, so it is worth thinking about them ahead of time:

• caffeine from coffee, tea, energy drinks or pre-workout supplements
• alcohol, especially after an evening of drinking
• nicotine and vaping
• poor sleep or shift work
• stress, worry and panic
• dehydration or skipped meals
• fever or a recent viral illness
• some cold and decongestant medicines, and certain prescription medications
• pregnancy, which naturally increases heart rate and blood volume
• hormonal changes, including around menopause
• thyroid problems

None of these should be treated as an explanation on your own. A list like this is a starting point for conversation, not a way to rule things in or out. Do not stop or change any prescribed medication because of palpitations without talking to the provider who prescribed it.

Why timing is the hard part

Here is the central challenge with palpitations: they are often there when you are not being tested, and gone when you are.

A person may have a run of fluttering most evenings after dinner and nothing at all during a ten-minute appointment the next morning. A normal recording at that moment is still useful information, but it cannot show what was happening during the episode itself.

So when a provider plans rhythm testing, one of the main things they are weighing is how often your symptoms happen. That single detail shapes which test is most likely to catch an episode.

A rough way to think about it

This is a general illustration, not a rule. Your provider will decide what fits your history, and they may combine tests or order them in sequence.

The resting EKG: a snapshot

An electrocardiogram, often called an EKG or ECG, is usually the first rhythm test. Small sensors are placed on the chest, arms and legs, and the machine records the heart’s electrical activity for a short period while you lie still.

At Durham Cardiology, the cardiology team at Rossland Diagnostic Clinic, an EKG takes about five to ten minutes. It is painless and does not put any stress on the heart. You bring your signed requisition and valid OHIP card, and no other special preparation is usually required.

A resting EKG can show the baseline rhythm, the rate, and features of the electrical tracing that a physician may want to note. If you happen to have palpitations during the recording, it may capture them. If you do not, it still gives your provider a reference point to compare with any longer recording.

Longer monitoring: following the rhythm through real life

When a snapshot is not enough, the next step is often a Holter monitor: a small portable recorder connected to sensors on the chest. It records continuously while you go about your normal life, at work, at home, and asleep. Durham Cardiology offers monitoring periods of 48 hours, 72 hours or 7 days, and the fitting itself takes about 15 minutes.

Your provider chooses the length. Broadly, a longer monitoring window gives more chances to record an episode that does not happen every day.

We have a separate, detailed guide on wearing a Holter monitor in Ajax that covers the fitting, sleeping, washing and returning the device, so we will not repeat it here. The part most relevant to palpitations is what you do while you wear it.

Making the recording count

A rhythm recording is most useful when your provider can line up what you felt with what the tracing shows at the same moment. A flutter you felt at 7:42 p.m. can be matched to the exact beats recorded at 7:42 p.m. That match is often more valuable than hours of quiet, normal rhythm.

When you notice palpitations during monitoring:

1. Note the time as exactly as you can. Your phone clock is fine.
2. Describe the sensation in plain words.
3. Write down what you were doing: climbing stairs, watching television, lying in bed, arguing on the phone.
4. Note how long it lasted and whether anything seemed to stop it.
5. Record any other symptoms, such as light-headedness or breathlessness.

Equally important: live as normally as you safely can. If your palpitations tend to appear after your evening coffee or on the walk up from the GO station, there is no benefit in avoiding those things during the test unless your provider has told you to. The goal is to record your rhythm during the situations that actually trigger your symptoms.

Before your appointment: a symptom diary

Whether or not you have been referred yet, a simple written record of your palpitations can be one of the most helpful things you bring to your provider. A week or two of notes often says more than a description from memory.

Try keeping track of:

• Date and time of each episode
• What it felt like: skipping, thumping, fluttering, racing, irregular
• Speed, if you can count your pulse at the wrist or neck for 30 seconds and double it
• Whether it started and stopped suddenly or built up and faded gradually
• Duration: seconds, minutes, longer
• What you were doing and what you had eaten or drunk
• Other symptoms that came with it
• Anything that helped, such as sitting down or slow breathing

Some people also use a smartwatch or a home blood pressure monitor that reports pulse. These can be useful prompts for a conversation, but they are not a substitute for testing ordered by your provider, and a reading from a consumer device should not be used to reassure yourself if you feel unwell. Bring screenshots if you have them and let your provider decide what to make of them.

When the rhythm test is not the whole story

Rhythm testing answers questions about the heart’s electrical pattern. Sometimes a provider also wants to know about the heart’s structure, or how it behaves under effort. In that case they may order other tests alongside or after a Holter, such as an echocardiogram, which uses ultrasound to look at the heart’s chambers and valves, or a monitored exercise test.

Each test answers a different question, and being sent for more than one does not mean something serious has been found. If you would like to understand how these fit together, our overview of heart testing in Ajax walks through each one side by side.

Your provider may also order blood work, for example to check thyroid function or blood counts. That is arranged separately through a laboratory.

What to ask your provider

Palpitations can be unsettling, and it is natural to want answers quickly. A few questions can help you understand the plan:

• What do you think is most likely, and what are you trying to rule out?
• Which test are you ordering, and why that one?
• How long will I wear a monitor, and what should I do if I have symptoms during it?
• Should I avoid anything before or during the test?
• Which symptoms mean I should go to emergency rather than wait?
• How and when will I hear about the results?

Results from rhythm testing are reviewed and reported to the provider who ordered them. They will explain what the recording showed and whether anything further is needed.

Booking rhythm testing in Ajax

Durham Cardiology is located inside Rossland Diagnostic Clinic at Unit 102, 300 Rossland Road East, Ajax, with free parking and ground-floor access. We are open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm, and we see patients from Ajax, Pickering, Whitby, Oshawa and across Durham Region.

If you have a requisition for an EKG or Holter monitor, call us at 905-426-3111 or request an appointment, and our team will help you find a time that works.