Palpitations, arrhythmias, and awareness of cardiac activity

Somatic and visceral symptoms have a surprisingly weak relationship to obje ctive measures of tissue pathology. This is exemplified by the poor correla tion found between palpitations and cardiac arrhythmias. Many factors other than extent of disease influence symptomatic distress, and since symptoms are such a crucial feature of illness and of medical practice, much more in vestigation of these nonbiomedical influences is needed. Although experimen tal laboratory paradigms facilitate such investigation, there are problems involved in generalizing from laboratory findings to the reporting of the s ymptoms of disease in daily life. In studying the awareness of cardiac arrh ythmias and of resting heartbeat, we have found that the palpitations of pa tients who somatize more and have more health-related anxiety and more psyc hiatric distress are significantly less likely to be related to demonstrabl e cardiac arrhythmias than are the palpitations of other patients. The accu rate awareness of arrhythmias, however, is not associated with the accurate awareness of resting heartbeat. Even more surprising, a relatively large p roportion of heart transplant recipients are accurately aware of their rest ing heartbeat. This work poses more questions than it answers. In so doing, it underscores some of the technical difficulties of conducting research i n this area and shows how little is known about symptom perception, process ing, and reporting.