Heart Palpitations

What are heart palpitations?

Heart palpitations are a feeling in your chest when your heartbeat is abnormal. Palpitations can be a fast heartbeat (or “heart flutter”), a skipped heartbeat, a slow heartbeat, or an irregular heartbeat.

Heart palpitations are usually nothing to worry about. But they can be a sign of a serious arrhythmia (abnormal heart rhythm) that needs to be treated with medication or surgery.

Most common symptoms

The sensation you feel in your chest can vary depending on the rate and pattern of your heartbeat. It often feels like your heart is racing or that the beat is not regular. Sometimes it can feel like a pounding in your chest, and you may have shortness of breath.

Main symptoms

• Racing heartbeat
• Erratic heartbeat
• Slow heartbeat

Other symptoms you may have

• Pounding in your chest
• Lightheadedness
• Dizziness
• Loss of consciousness
• Shortness of breath

Next steps

If you are experiencing heart palpitations and also have chest pain or trouble breathing, go to the emergency room right away.

Otherwise, see your primary care physician. Your doctor can do a screening test such as an electrocardiogram (EKG), which captures the electrical activity of the heart. You may also be given an ambulatory EKG monitoring device, which is a wearable device you take home that records your heart’s electrical activity for an extended period of time.

Your doctor may order a blood test to check for electrolyte (potassium) or hormonal abnormalities that could be triggering your palpitations. Depending on what the test results show, you might be referred to a specialist, such as a cardiologist or an endocrinologist (hormone doctor), for further treatment.

A cardiologist might recommend you have an echocardiogram (an ultrasound of the heart) to check your heart’s valves, walls, and ability to pump blood.

Causes

Heart conditions

Problems with the heart’s conduction system (or the electrical circuit), the heart valves, or its structure can cause heart palpitations. These conditions are among the most serious causes of palpitations and should be treated by a cardiologist. Many types of heart conditions can cause palpitations, but the more common ones include:

• Atrial fibrillation
• Atrial flutter
• Ectopic beats
• Heart block
• Mitral valve prolapse
• Atrial septal defect

Hormone abnormalities or changes

Most of the body’s actions are controlled by various hormones. Levels of these hormones are tightly regulated so that each of your body’s organs functions properly. But too much or too little of these hormones can cause problems including heart palpitations. These include:

• Hyperthyroidism
• Pheochromocytoma
• Pregnancy

Low blood sugar

Heart palpitations, along with lightheadedness and sweating, are signs that your blood sugar is low.

Anxiety

The entire spectrum of anxiety disorders—from generalized anxiety to panic attacks—is a common cause of heart palpitations. Stress is also a common cause of palpitations. Your body produces an excess of certain hormones during periods of high stress that can lead to feeling jittery or having palpitations.

Substance use

• Smoking cigarettes
• Drinking excessive alcohol
• Drinking too much coffee
• Using certain illegal drugs (cocaine, methamphetamines)

Medication

Side effects or withdrawal of certain medications, such as cold or cough medicine, asthma inhalers, diet pills, or antibiotics can cause palpitations.

Risk factors

Risk factors for heart palpitations include having pre-existing heart problems, such as congestive heart failure or atrial fibrillation.

Risk factors for people without known heart problems include:

• Advanced age
• Hormone abnormalities
• Smoking tobacco
• Excessive alcohol consumption
• Psychiatric conditions
• Use of certain drugs

Treatment

Treatment of heart palpitations depends on the cause. The most common heart conditions that cause palpitations are abnormal heart rhythms, such as atrial fibrillation. Atrial fibrillation can be treated with medications that slow down the heart rate, such as beta-blockers or calcium-channel blockers.

If these medications aren’t helping enough, then your doctor might consider a special procedure called a catheter ablation, which tries to fix the cause of the abnormal heart rhythm and restore a normal heartbeat.

If your heart palpitations are caused by an abnormally slow heartbeat, then you may need a pacemaker to help speed up the heart rate.

If palpitations are triggered by stress or anxiety, the goal is to treat the underlying issues. This includes stress reduction techniques, such as meditation and psychotherapy or medication for anxiety.

If you have a hormonal issue, you may need to see an endocrinologist (hormone doctor) to discuss treatment, which may include medications or surgery to correct the hormonal imbalance.

Palpitations caused by medication or substance abuse are treated by withdrawing the drug or substance.

Preventative tips

• Limit caffeine.
• Limit alcohol.
• Avoid stressors.
• Avoid using illegal drugs.
• Eat meals at regular intervals.
• Quit smoking.