Palpitations: Understanding Causes, Symptoms, and When to Seek Help
Discover what heart palpitations mean, their common causes, symptoms, and when to seek medical help for your heartbeat concerns.
Palpitations are sensations in which you become aware of your heartbeat—whether it feels fast, strong, irregular, or just unusual for you. These experiences are common and, in most cases, not dangerous, but sometimes they may signal an underlying health issue that needs attention.
What Are Palpitations?
Palpitations refer to the conscious awareness of your heart beating. You may feel your heart:
- Racing or pounding
- Fluttering or skipping beats
- Beating irregularly or more forcefully than usual
Such sensations can occur in your chest, throat, or neck. Although palpitations might be alarming, they’re often temporary and not a sign of a serious problem. However, in certain instances, they can stem from arrhythmias (abnormal heart rhythms) or other medical conditions that require medical evaluation.
What Do Palpitations Feel Like?
Descriptions of palpitations can vary between people, but some of the most commonly reported sensations include:
- Rapid, fluttering or pounding heartbeat
- Heart “skipping” a beat, or extra beats
- Feeling as though your heart is turning over within your chest
- Awareness of your heartbeat in your throat or neck
- Irregular or thumping beats
Palpitations may occur at rest, during activity, lying down, or while standing. For many, anxiety related to the sensation itself can further intensify palpitations.
What Causes Palpitations?
There are numerous reasons why you might experience palpitations. They’re most commonly temporary and harmless, but sometimes a medical investigation is needed to rule out underlying problems.
Common Causes
- Stress and Anxiety: Emotional surges, panic attacks, and persistent worry are frequent triggers.
- Physical Activity: Exercise or sudden exertion can make you more aware of your heartbeat.
- Stimulants: Nicotine, caffeine (from coffee, tea, energy drinks), and some cold medicines or inhalers.
- Medications: Certain prescription and over-the-counter drugs, such as asthma inhalers, decongestants, or thyroid medication.
- Hormonal Changes: Pregnancy, menstruation, menopause, or hormonal disorders like hyperthyroidism.
- Substance Use: Alcohol, recreational drugs (such as cocaine or amphetamines), or excessive caffeine intake.
Medical Conditions Linked to Palpitations
- Heart rhythm disorders (Arrhythmias): Including atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, and others.
- Structural heart abnormalities: Such as congenital heart disease or heart failure.
- High output states: Such as anemia, pregnancy, fever, sepsis, or hyperthyroidism.
- Metabolic conditions: Like low blood sugar (hypoglycemia), electrolyte disturbances (low or high levels of potassium, calcium, or magnesium), and pheochromocytoma.
- Other health issues: Such as orthostatic hypotension or postural orthostatic tachycardia syndrome (POTS).
- Psychiatric disorders: Panic disorder and other anxiety-related conditions.
| Cardiac Causes | Non-Cardiac Causes |
|---|---|
| Atrial fibrillation or flutter Supraventricular tachycardia Ventricular tachycardia Premature atrial or ventricular contractions Heart blocks | Anxiety or panic attacks Hormonal fluctuations Medications or stimulants Metabolic conditions Fever or infection |
Are Palpitations Dangerous?
Most heart palpitations are benign and don’t signify a dangerous problem, especially if they’re isolated incidents or linked to readily identifiable factors like caffeine, stress, or exercise. However, some palpitations are symptoms of potentially serious cardiac arrhythmias or conditions requiring medical evaluation.
What others are reading
Rarely, palpitations may signal a more serious issue, particularly if accompanied by:
- Chest pain or discomfort
- Fainting or near-fainting (syncope)
- Severe dizziness or shortness of breath
- Unusual sweating or weakness
If you experience any of these symptoms along with palpitations, seek immediate medical attention.
What Are Heart Arrhythmias?
Heartbeat irregularities, or arrhythmias, are common culprits for palpitations. Arrhythmias refer to any abnormal rhythm—whether too fast, too slow, or erratic. Some types are harmless; others need medical treatment.
Types of Heart Arrhythmias Associated with Palpitations
- Premature Atrial Contractions (PACs): Extra beats from the atria (upper heart chambers)
- Premature Ventricular Contractions (PVCs): Extra beats from the ventricles (lower heart chambers)
- Paroxysmal Supraventricular Tachycardia (PSVT): Sudden episodes of rapid heart rate from above the ventricles
- Atrial Fibrillation or Flutter: Irregular or fast heartbeats from the atria
- Ventricular Tachycardia: Fast, abnormal rhythm from the ventricles (may be life-threatening)
- Bradyarrhythmias: Abnormally slow rhythms or heart blocks
Some arrhythmias may only be discovered during a medical evaluation or via special monitoring equipment, as they can be brief and hard to capture while you’re at the clinic.
Who Gets Palpitations?
Palpitations are common and can occur at any age. However, they are more frequently reported by:
- Women, particularly during pregnancy, menstruation, or menopause
- People with anxiety or high-stress jobs
- Individuals who use stimulants (caffeine, nicotine, certain medicines)
- People with pre-existing heart disease or a family history of arrhythmias
For most, occasional palpitations are part of normal life. But for those with risk factors or accompanying symptoms, evaluation is important to rule out underlying conditions.
How Are Palpitations Evaluated?
A careful evaluation combines your personal and family history, a physical examination, and selected tests to pinpoint both the cause and any underlying health risks.
Information Your Doctor May Ask
- When do you notice palpitations?
- How long do they last?
- What were you doing at the time?
- Do they occur with exercise, at rest, or at night?
- Have you fainted, felt dizzy, or had chest pain?
- Are you using any medications, supplements, caffeine, nicotine, or recreational drugs?
- Does anyone in your family have heart disease or arrhythmias?
Common Diagnostic Tests
- Physical examination: To assess your heart rate, rhythm, blood pressure, and signs of underlying disease.
- Electrocardiogram (ECG/EKG): A snapshot of your heart’s electrical activity; helpful if palpitations occur during testing.
- Holter Monitor: Portable ECG worn for 24–48 hours to capture intermittent events.
- Event Recorder: Device worn for days to weeks; triggered by symptoms.
- Blood tests: To check for problems such as thyroid disease, electrolyte imbalances, or anemia.
- Echocardiogram: Ultrasound exam to assess heart structure and function.
- Exercise Stress Test: For evaluation during or after physical activity.
How Are Palpitations Treated?
Treatment for palpitations depends on the underlying cause and the severity of symptoms. For most benign cases, reassurance and simple lifestyle modifications are all that is needed. However, more serious or persistent palpitations may require targeted treatment.
Lifestyle Changes and Home Remedies
- Cut back or avoid caffeinated drinks and stimulants
- Stop smoking and avoid recreational drug use
- Practice stress management (deep breathing, meditation, yoga, relaxation techniques)
- Get regular physical exercise suited to your health condition
- Maintain good hydration and avoid crash dieting
- Track triggers and avoid known causes when possible
Medical Treatments
- Medications: For those with arrhythmias or certain underlying medical issues
- Treatment of underlying conditions: Such as thyroid problems, anemia, or heart disease
- Referral to a cardiologist: For cases of unexplained, severe, or persistent palpitations, or when arrhythmias are detected
- Procedures: In some cardiac rhythm disorders, procedures such as catheter ablation or pacemaker implantation may be necessary
How Can I Prevent Palpitations?
For many people, palpitations can be minimized with healthy living and effective management of stress or medical issues. Prevention strategies include:
- Reducing intake of caffeine, nicotine, and alcohol
- Avoiding recreational drugs
- Managing emotional stress and anxiety constructively
- Getting regular physical activity, within your health limits
- Following prescribed management for existing conditions such as thyroid disease or heart disorders
When Should I See a Doctor for Palpitations?
Most palpitations aren’t dangerous, but some require medical attention. See a doctor promptly if you have palpitations in any of these situations:
- Chest pain, discomfort, or pressure
- Shortness of breath
- Severe dizziness, lightheadedness, or fainting
- History of heart disease, heart attack, or stroke
- Palpitations that worsen or become more frequent
- Symptoms that occur with physical activity or disrupt daily life
Early evaluation of serious symptoms can be lifesaving, particularly for those at risk of dangerous arrhythmias.
Frequently Asked Questions (FAQs)
Q: Can dehydration cause palpitations?
A: Yes. Dehydration can lower blood pressure and change electrolyte balances, leading to palpitations in some individuals.
Q: Are palpitations dangerous?
A: Most are not, but those associated with chest pain, fainting, or shortness of breath can indicate a serious issue and should be evaluated promptly.
Q: Should I stop exercising if I get palpitations?
A: Occasional palpitations during exercise are often benign, but stop immediately and seek help if you experience chest pain, lightheadedness, or fainting.
Q: Can anxiety cause palpitations?
A: Absolutely. Anxiety and panic attacks are among the most common causes of palpitations, and they’re usually harmless, though sometimes distressing.
Q: What tests will my doctor use to find the cause?
A: Your doctor may use an electrocardiogram (ECG), Holter monitor, blood tests, or an echocardiogram, depending on your symptoms and history.
Key Points to Remember About Palpitations
- Palpitations are common and typically not a sign of a serious problem.
- Many triggers are benign, including stress, caffeine, or strenuous activity.
- Occasional palpitations without other symptoms generally do not require treatment.
- Seek prompt care if you experience palpitations alongside chest pain, fainting, or severe breathlessness.
- Consult your healthcare provider for persistent, frequent, or troubling symptoms.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8905373/
- https://www.bme.jhu.edu/news-events/news/new-study-uncovers-major-cause-of-deadly-heart-arrhythmias/
- https://www.bme.jhu.edu/news-events/news/hopkins-lab-develops-arrhythmia-treatment/
- https://pure.johnshopkins.edu/en/publications/orthostatic-hypotension-management-of-a-complex-but-common-medica
- https://www.youtube.com/user/johnshopkinsmedicine
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