Fehaid Alanazi et al, 2020;4(2):383–388. International Journal of in Developing Countries https://doi.org/10.24911/IJMDC.51-1575930917

ORIGINAL ARTICLE 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

ABSTRACT Background: 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 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 , valvular heart , , and pacemakers. The second most common is of psychiatric origins, such as a attack, , , 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 toward palpitations and side effects of energy drinks symptoms to outpatient cardiologist/internists’ clinics, consumption [4]. Palpitation has a wide extensive which represents 16 percent out of 500 medical in a study conducted among 190 outpatients [1]. Palpitation is defined as a rapid pulsation, patients presented to the clinic with chief complain of an abnormally rapid or irregular beating of the heart. palpitations. It showed that among the 190 patients, Palpitations are a sensory symptom and are often in 84% the cause was determined, the most common described as a skipped beat, rapid fluttering in the chest, cause was cardiac origin (43%), and 31 present were 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]. Correspondence to: Khalid Ayidh Alotaibi Regarding the prevalence of heart palpitations in Saudi *Medical Intern, Majmaah University, Al Majmaah city, Arabia, 20% participants, out of 257 medical students Saudi Arabia. Email: [email protected] at Umm Al-Qura University in 2013, experienced Full list of author information is available at the end of palpitations as a side effect of energy drinks consumption the article. [3]. Goyal et al [4] recommended for more awareness Received: 09 December 2019 | Accepted: 26 December 2019 companies and clubs to increase the awareness

© IJMDC. https://www.ijmdc.com 383 Awareness of population toward palpitation

due to psychiatric causes, miscellaneous causes (e.g., record 24–48 hours to assess any cardiac abnormalities medication-induced, thyrotoxicosis, caffeine, cocaine, during the day [8]. Patients who experience palpitations , amphetamine, mastocytosis) were only 10% with exertion should be evaluated with standard exercise [5,6]. Another study was conducted in 2003, among 184 stress testing because they are at higher risk of morbidity participants who complained of palpitations in the out- and mortality. An electro-physiologic study may be patient cardiac clinic, it showed 34% had , warranted in patients with palpitations preceded by and 41% had extrasystoles and also showed awareness of or near-syncope, as well as in those in whom sinus rhythm in 26% [7]. there is a high index of suspicion of a cardiac origin not In their study, they (Nymes, Mathiesen, Njolstad, diagnosed with other studies. ECG helps to evaluate Wilsgaard, & Lochen, 2012) examined the effects the patients for structural heart and should be of palpitations and cardiovascular risk factors in the performed when initial history and prediction of atrial (AF). The study involved are unrevealing, or in patients with a history of cardiac a massive population-based cohort design and samples disease or more complex (e.g., of 22,815 study participants were involved. For data dyspnea, , and lower extremity ) [9]. analysis purposes, the researchers used a regression The management of palpitations is determined by the model to generate Cox proportional hazards that played underlying cause of the symptoms [10]. Radiofrequency a significant role in the estimation of hazard ratios for ablation can most types of supraventricular and AF. The results showed that women have high chances of many types of ventricular [10]. The most getting AF compared to men. Besides, it was evident that challenging cases involve palpitations that are secondary body mass index and height have high risks on AF in men. to supraventricular or ventricular ectopy or associated The study concluded that palpitations, body mass index, with normal sinus rhythm. These conditions are and leads to AF in both men and women. to be benign, and the management involves reassurance of Palpitations due to cardiac origin could be because the patient that these arrhythmias are not life threatening. of any reason, including arrhythmias, valvular heart In these situations, when the symptoms are unbearable or diseases, cardiomyopathy, and pacemakers. The second incapacitating, treatment with beta-blocking medications most common cause is of psychiatric origins, such as could be considered and may provide a protective effect a , anxiety, depression, and somatization. for otherwise healthy individuals [11]. Also, other causes can cause palpitations like The management of most sustained supraventricular or medications (Sympathomimetics agents, vasodilators, ventricular arrhythmias causing palpitations involves anticholinergics, and beta-blockers withdrawal), cocaine, referral to a specialist trained in the pharmacologic and amphetamines, caffeine consumption, and . invasive electrophysiologic management of arrhythmias. Metabolic disorders can cause palpitations, such as Most types of regular supraventricular and , thyrotoxicosis, and . some types of ventricular tachycardias are now curable Anemia, , , stress, and exercise are the with radiofrequency ablation [12]. Patients who present causes of palpitations [5,6]. to the emergency department who are , with To determine the cause of the palpitations, a careful unremarkable physical examinations, non-diagnostic history and physical examination should be done. Patients ECGs and normal laboratory values, can safely be sent may describe palpitations in a variety of ways, such as home and instructed to follow up with their primary care a fluttering, pounding, or uncomfortable sensation in provider or cardiologist. Patients whose palpitations the chest or neck, or simply an increased awareness of are associated with syncope, uncontrolled arrhythmias, the heartbeat. History should include age to narrow the hemodynamic compromise, or should be admitted differential diagnosis, socio-demographic data, stressors for further evaluation [2]. and psychiatric illness screening, drug and energy drinks The results of this study would enable the healthcare should be screened also [8]. sector to develop effective policies and reforms that Physical examination primarily serves to determine would address palpitation and its risk factors, both in the if there are cardiac or other abnormalities present present and in the future. Using the results of this study, that might predispose the patient to palpitations. The scholars would be able to conduct further research and physician should look for evidence of address the existing gaps identified in the research. (e.g., nervousness, heat intolerance), drug use, or other Subjects and Methods serious illnesses. Finally, in the occasional patient who has palpitations with exercise, the examination of the This study adopted a cross-sectional design, conducted patient after he or she exercises may reveal an arrhythmia in Riyadh region, Saudi Arabia, 2019. Riyadh is located or murmur that is exacerbated by the resulting increased at the center of Saudi Arabia and it occupies an area and cardiac output. 12-lead Echocardiography of 404,240 kilometers per square and has a population (ECG) should be done to the patient who complains of of approximately 8.2 million people. Riyadh region is palpitations, to exclude cardiac causes. Complete blood known to be the capital city of Saudi Arabia. The study count and hormonal studies should be ordered to assess distributed among the adult population who were both the causes of palpitations. Continue ECG monitoring to

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male and female in Riyadh region, Saudi Arabia. The Table 1. Socio-demographic data analysis. study adopted a census approach as a sampling technique Frequency Percent based on the assumption that all adult males and females were agreed to answer the questionnaire in this Age Less than 18 38 11.5 study. The study included 382 participants. Pre-tested, 18–30 103 31.1 electronic questionnaires were used in data collection. 31–40 93 28.1 The questionnaire included questions about socio- 41–50 60 18.1 demographic factors, awareness of palpitations among More than 50 36 10.9 the adult population in the Central Region, Saudi Arabia. Gender Male 148 44.7 Once the data had been collected, it was important to Female 182 55.0 analyze it with the purpose and objectives of the study and as a result, generate meaning results, conclusion, Residency Riyadh 88 26.6 and recommendations of the study. In data analysis, Others 46 13.9 there were various steps involved, which included data Qassim 42 12.7 cleaning, data coding, and data aggregating. This study Sudair 154 46.5 analyzed the collected data using Statistical Package Nationality Saudi 308 93.1 for the Social Sciences version 22, whereby descriptive statistics, bivariate statistics, and numerical analysis Non-Saudi 22 6.6 were generated. Marital status Single 149 45.0 Ethical consideration in the case of this study, the Married 168 50.8 researcher ensured that the data gathered from the Widowed 6 1.8 respondents would only be used for this study and in Divorced 7 2.1 case of misleading information; the researcher would Level of education Primary 8 2.4 undertake an ethical procedure to solve the problem. Secondary 109 32.9 Besides, the researcher would be responsible for protecting the confidentiality of the respondents. The Bachelor 138 41.7 information gathered would adhere to the benefits Intermediate 15 4.5 and the intended purposes of the study. To provide an Other 30 9.1 accurate and fair view of the study, the study seeks the Postgraduate 30 9.1 anonymity of the participants and this enhanced privacy studies and confidentiality of the study’ participants. Occupation Employed 162 48.9 Results Unemployed 168 50.8

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 hence, we concluded that there is a relationship between years of age. Most of the populations were female (55%), medication used and experiencing palpitation. while 44.7% were males. Most of the participants lived Table 5 is a cross-tabulation of participants experiencing in Sudiar; majority was married (50.8%), while only a any heart Palpitations with some health problems. few (2.1%) were divorced. From Table 5, it is observed that 16 participants Table 2 displays the general awareness of the respondents were experiencing Mellitus alongside with regarding Palpitations. Among the participants, 45% Hypertension, 10 were suffering from diseases, believe that all the listed associated symptoms of 12 from pulmonary diseases. However, six persons palpitation make them go to the ER. However, 10.6% were suffering from Diabetes Mellitus alongside with believe that chest make them go to the ER. Moreover, Hypertension but they don’t even know if they were 63.7% thinks there is a relationship between palpitations experiencing heart Palpitation. and caffeine consumption. To define Palpitation, 78.9% Table 6 is a Chi-Squared test to ascertain the relationship says it is the noticeably abnormal rapid or irregular between participants experiencing any heart Palpitations beating of the heart. with some health problems. It is seen that the p-value From the cross-tabulation Table 3, the number of is 0.000, which is less than 0.05; hence, we conclude persons who had experienced any heart Palpitations and that there is a significant relationship between health currently taking medications were 70; however, 106 of problems and experiencing palpitation. the participants had not experienced Palpitations, hence Discussion were not taking any medications. Table 4 is a Chi-Squared test to see the relationship The purpose of this study was to ascertain the awareness between medication used and experiencing palpitation. of palpitations among the adult population in Riyadh Since the p-value is 0.000, which is less than 0.05, Region, Saudi Arabia. Specifically, to assess the level of

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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 Thyroxine 21 6.3 question with Yes, please answer this Ventolin 23 6.9 question. Other 158 47.7 What is the definition of palpitation? Noticeably abnormal rapid or 261 78.9 irregular beating of the heart. 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 Yes 159 48.0 palpitations? No 153 46.2 I don’t know 18 5.4 Do you think there is a relationship Yes 211 63.7 between palpitations and caffeine No 20 6.0 consumption? I don’t know 99 29.9 32 9.7 Which of the following associated 35 10.6 symptoms with palpitation makes Drowsiness 15 4.5 you go the ER? 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

awareness of the general population in the Riyadh region Sudiar; majority (50.8%) was married, while only a few of Saudi Arabia toward Palpitation, and also to assess the (2.1%) were divorced. Among the participants, 16.3% relationship between the level of awareness and socio- work in the health field, while 32.6% do not. Most of the demographic data. The socio-demographic data shows respondents had an income level less than 3,000. Among that a high percentage of the respondents were more than the participants, 39% happened to be on medication, 50 years of age as just 11.5% of the respondents were and 6.9% of them were on Ventolin medication, while less than 18. Most of the participants were female (55%), 47.7% were on other medication. A study conducted by while 44.7% were males. Most of the participants lived in Hafiz Muhammad Aslam, Anum Mughal, Muhammad

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Muzzammil Edhi, on the topic that assesses the pattern and Sima Sadrai, aimed to screen for mental disorders for consumption and awareness regarding energy drinks in patients complaining of palpitation and healthy among medical students showed that most common side persons to perform a preliminary comparison between effects reported by users were (111) (31.7%) and them. This is a case-control study to screen mental weight gain (102) (29.4%), and out of the 350 energy disorders. The target population consisted of adult drink users, 36.6% of them believe that energy drinks volunteers with benign palpitation and their matched cause palpitations, hypertension and heart problems. healthy persons. Comparing two groups showed that the Hence, this warrants the creation of continued public number of participants with the scores more than a cut- health awareness about the appropriate use of caffeinated off point in palpitation group was significantly more than beverages, their potential benefits, side effects, and healthy person group (85.4% vs. 43.6% with p < 0.001). correction of wrong perceptions [12]. The relationship According to the results of the study, palpitation was the between Palpitation and Mental Health was a research most common symptom in psychiatric disorders, such as conducted by Fatemeh Alijaniha, Ahmadali Noorbala, anxiety and somatization disorders. Psychiatric causes Suleiman Afsharypuor, Mohsen Naseri, Faramarz Fallahi, Mahmood Mosaddegh, Soghrat Faghih Zadeh,

Table 6.

Chi-Square Tests Table 4. Asymptotic Chi-Square Tests Value df Significance (2-sided) Asymptotic a Value df Significance Pearson Chi-Square 371.253 36 .000 (2-sided) Likelihood Ratio 58.079 36 .011 Pearson Chi-Square 342.914a 6 .000 N of Valid Cases 331 Likelihood Ratio 25.432 6 .000 a41 cells (78.8%) have N of Valid Cases 331 expected count less than 5. The minimum a6 cells (50.0%) have expected count less than 5. The minimum expected count is .00. 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 AQ 1 0 0 0 1 of the following health None 0 86 102 8 196 problems: (you can choose more than one ) Psychiatric diseases 0 8 3 2 13 Pulmonary diseases 0 12 4 0 16 Pulmonary diseases; Psychiatric 0 3 1 1 5 diseases Thyroid diseases 0 10 7 1 18 ; 0 3 1 0 4 Diabetes Mellitus; Hypertension Cardiovascular disease; 0 6 0 0 6 Pulmonary diseases; Diabetes Mellitus; Hypertension Cardiovascular disease 0 4 2 0 6 Cardiovascular disease; Thyroid 0 6 0 0 6 diseases; Diabetes Mellitus; Hypertension 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

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