5. Palpitations: The Heart’s Distress Signal
Palpitations experienced by patients with hematemesis are more than just heartbeats—they are the palpable expression of the heart struggling to maintain an effective circulation amidst the crisis of internal bleeding. These sensations of a racing, pounding, or fluttering heartbeat are the body’s attempt to compensate for the decreased volume of blood by increasing the heart rate.
This symptom of palpitations can be both felt and heard: patients often report being able to hear their heartbeat in their ears. The experience can be episodic or sustained, and while it may be a benign symptom in other contexts, in association with hematemesis, it is often a sign of significant concern.
The etiology of palpitations in this scenario can often be traced to a sympathetic nervous system response. The body, recognizing the drop in blood volume and pressure, initiates a cascade of hormonal responses that result in the heart beating faster and harder in an attempt to distribute what little blood is available to vital organs.
The character of these palpitations can vary. Some may experience a regular rapid heartbeat, known as tachycardia, while others may feel irregularities or skipped beats, which are known as arrhythmias. The presence of an arrhythmia in the context of hematemesis can be particularly concerning as it may indicate not only a response to blood loss but also potential electrolyte imbalances or direct cardiac involvement.
Further complicating the clinical picture is the fact that palpitations can induce fear, anxiety, and panic in patients, which can further stimulate the sympathetic nervous system, creating a feedback loop that exacerbates the heart’s distress. It is critical to interrupt this cycle, not only to alleviate the uncomfortable symptom of palpitations but to address the underlying cause of the hematemesis and associated blood loss. (5)
