Heart Palpitations

What Are Heart Palpitations?

Heart palpitations are the sensation of being aware of your heartbeat. They may feel like your heart is racing, pounding, fluttering or skipping beats. Palpitations can occur at rest or during activity and may be felt in the chest, neck or throat. Heart palpitations are fairly common, affecting up to 10% of people in the U.S, according to a study published in the National Institutes of Health.

In many cases, heart palpitations are harmless and short-lived. They are often triggered by stress, anxiety, lack of sleep or stimulants such as caffeine or nicotine. However, palpitations can sometimes be a sign of an underlying heart rhythm problem, such as atrial fibrillation, especially when they occur frequently or are accompanied by other symptoms.

Because heart palpitations can have many causes, it’s important to discuss new or concerning changes in heart rhythm with your doctor. This helps rule out more serious conditions and ensures you receive appropriate care.

Causes

Heart palpitations can be caused by a wide range of everyday factors as well as medical conditions. Common causes include:

• Alcohol use
• Certain prescription or over-the-counter medications
• Exercise or physical exertion
• Illegal drugs such as methamphetamines
• Menopause
• Pregnancy
• Sleep deprivation
• Stress or anxiety
• Stimulants such as caffeine or nicotine or energy drinks

Less commonly, heart palpitations may be related to medical conditions such as anemia, overactive thyroid disease or heart rhythm disorders like arrhythmia or atrial fibrillation.

Because heart palpitations can have many causes, it’s important to discuss new or concerning changes in heart rhythm with your doctor. This helps rule out more serious conditions and ensures you receive appropriate care.

Signs and Symptoms

The most common symptom of heart palpitations is the sensation of a faster or abnormal heartbeat. This may include:

• A fluttering sensation
• A pounding heartbeat
• A racing heartbeat
• The feeling that your heart has skipped or added a beat

Palpitations may occur during periods of stress or anxiety, at night, after eating or during pregnancy. In some people, they occur without an obvious trigger.

When to Seek Emergency Care

Call 911 or seek emergency medical care right away if heart palpitations are accompanied by:

• Chest pain or pressure
• Fainting, loss of consciousness or lightheadedness
• Severe shortness of breath
• Severe dizziness or confusion

These symptoms may indicate a serious heart or circulation problem.

Diagnosis

Before you visit your doctor, it can be helpful to note:

• When palpitations start and stop
• How often they occur
• What you were doing at the time
• Foods, drinks or medications taken beforehand
• Associated symptoms such as dizziness or shortness of breath

This information can make diagnosis faster and more accurate.

When you are being evaluated, your doctor will begin by performing a careful medical history and physical examination. Your doctor will ask about when the palpitations occur, how long they last and whether anything seems to trigger or relieve them. Lifestyle factors such as sleep habits, stress levels, diet and medication use are also important.

Depending on your symptoms, your doctor may recommend one or more tests to evaluate heart rhythm and overall heart health.

Breathing and Exercise Tests

Exercise Testing

Exercise testing, often done on a treadmill or stationary bike, evaluates how the heart responds to physical activity. Heart rhythm, heart rate, blood pressure, and symptoms are monitored while exercise intensity gradually increases. This test can reveal exercise-induced arrhythmias or reduced blood flow to the heart that may cause palpitations. It also helps doctors assess overall cardiovascular fitness and symptom patterns during exertion.

Cardiac Tests

Echocardiogram

An echocardiogram is an ultrasound test that uses sound waves to create moving images of the heart. It shows the heart’s structure, pumping strength, and how well the valves are working. While it does not record heart rhythm directly, it helps identify structural heart problems that can contribute to palpitations. This information helps doctors determine whether palpitations are related to underlying heart disease.

Electrocardiogram

An electrocardiogram is a quick, painless test that records the heart’s electrical activity using small sensors placed on the skin. It shows how fast the heart is beating and whether the rhythm is regular or irregular. An ECG can identify arrhythmias, prior heart damage, or conduction problems that may be causing palpitations. Because it captures only a brief moment in time, results may be normal if palpitations are not happening during the test.

Cardiac Monitor

A cardiac monitor is a portable device worn for one day to several weeks to continuously record heart rhythms. It allows doctors to detect abnormal heartbeats that come and go and may not appear during a standard ECG. A cardiac monitor records continuously, while an event monitor is triggered by symptoms or automatically when irregular rhythms occur. These monitors are especially helpful for linking palpitations to specific heart rhythm changes. Sometimes monitoring will go on for up to 30 days.

Implanted Loop Recorder (ILR)

For more serious cases, a small pen-cap-sized device can be inserted under the skin to monitor for arrhythmias for several years.

Lab Tests

Blood tests

Blood tests help identify medical conditions that may trigger or worsen heart palpitations. They can detect issues such as anemia, thyroid disorders, metabolic disturbances, electrolyte imbalances, or signs of infection or inflammation. Certain blood tests may also check medication levels or markers of heart stress. Treating these underlying problems can often reduce or resolve palpitations.

Treatment

Heart palpitations do not always require treatment. When they are mild and infrequent, reassurance and lifestyle adjustments may be all that is needed. Treatment depends on the cause, frequency and severity of symptoms. If palpitations are caused by issues such as overactive thyroid disease, anemia or electrolyte imbalances, treating the underlying condition may reduce or eliminate symptoms.

Medications

If palpitations are caused by an underlying heart rhythm disorder or medical condition, your doctor may prescribe medications to control heart rate or rhythm. Medication choices depend on the specific diagnosis and your overall health.

Common medication categories include:

• Antiarrhythmic medications: In people with documented rhythm disorders, antiarrhythmic drugs may be used to help maintain a more regular heart rhythm. These medications require careful monitoring due to potential side effects.
• Beta blockers: These medications slow the heart rate and reduce the effects of stress hormones on the heart. They are often used when palpitations are related to anxiety, stress or certain arrhythmias.
• Calcium channel blockers: These drugs help regulate heart rate and can be useful for some abnormal heart rhythms, particularly when beta blockers are not well tolerated.

Medication decisions should always be guided by a clinician, as some drugs can worsen palpitations in certain situations.

Procedures

Procedures are considered when heart palpitations are caused by persistent or clinically significant heart rhythm disorders and do not respond adequately to medications or lifestyle changes. These treatments are typically managed by a cardiologist or heart rhythm specialist.

Examples include:

• Catheter ablation: This minimally invasive procedure uses thin catheters guided through blood vessels to target and treat areas of heart tissue that are triggering abnormal rhythms. Ablation may reduce or eliminate palpitations caused by certain arrhythmias.
• Electrical cardioversion: In some rhythm disorders, a controlled electrical shock may be used to restore a normal heart rhythm. This is usually performed in a monitored medical setting.
• Implanted devices: Pacemakers or other implanted devices may be recommended in select cases when palpitations are associated with slow or irregular heart rhythms that affect heart function.

Not everyone with heart palpitations will need a procedure. Your care team will carefully weigh risks, benefits and alternatives before recommending an intervention.

Lifestyle Management

Lifestyle changes often play an important role in managing heart palpitations. These may include:

• Avoiding heavy or spicy meals if symptoms occur after eating
• Avoiding illicit substances
• Getting adequate sleep
• Limiting alcohol intake
• Maintaining a heart-healthy diet and regular, moderate exercise
• Managing stress through relaxation techniques
• Reducing or eliminating caffeine, nicotine and energy drinks

Your doctor can help tailor recommendations based on your triggers and overall health.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with heart diseases have access to clinical trials and should speak with their physician to determine what trials might work best for them.

When to See a Specialist

It’s important to be evaluated by a cardiologist if you or a loved one:

• Has palpitations that are frequent, persistent or worsening
• Has palpitations that occur with lightheadedness, shortness of breath or fatigue
• Has a history of heart disease
• Has noticed new symptoms you haven’t experienced before

At National Jewish Health in Denver, Colorado, we have one of the region’s most respected cardiology programs. Learn more about our program or use the button below to make an appointment.