Heart palpitations

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Causes

Heart palpitations can be due to:

  • Anxiety, stress, panic attack, or fear
  • Caffeine intake
  • Cocaine, methamphetamine or other stimulant drugs
  • Decongestant medications, such as phenylephrine or pseudoephedrine
  • Diet pills
  • Exercise
  • Fever
  • Nicotine intake
  • Excessive alcohol consumption

However, some palpitations are due to an abnormal heart rhythm, which may be caused by:

  • Heart disease
  • Abnormal heart valve, such as mitral valve prolapse
  • Abnormal blood level of potassium
  • Certain medicines, including those used to treat asthma, high blood pressure, or heart problems
  • Overactive thyroid
  • Low level of oxygen in your blood

Considerations

Normally the heart beats 60 to 100 times per minute. The rate may drop below 60 beats per minute in people who exercise regularly or take medicines that slow the heart.

If your heart rate is fast (over 100 beats per minute), this is called tachycardia. A heart rate slower than 60 is called bradycardia. An occasional extra heartbeat out of rhythm is known as extrasystole.

Palpitations are not serious most of the time. Sensations representing an abnormal heart rhythm (arrhythmia) may be more serious.

The following conditions make you more likely to have an abnormal heart rhythm:

  • Known heart disease at the time the palpitations begin
  • Significant risk factors for heart disease
  • An abnormal heart valve
  • An electrolyte abnormality in your blood -- for example, a low potassium level

Definition

Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck.

You may:

  • Have an unpleasant awareness of your own heartbeat
  • Feel like your heart skipped or stopped beats

Your heart's rhythm may be normal or abnormal when you have palpitations.

Which of these may be a symptom of heart palpitations?The correct answer is all of the above. You may have one or more of these symptoms.Are palpitations dangerous?The correct answer is maybe. Most of the time, palpitations are not dangerous. Palpitations are only a symptom and not an illness or medical problem. However, heart palpitations can also be a sign of a serious heart problem. Talk to your doctor about your symptoms to be safe.If you're experiencing frequent or severe heart palpitations, how soon should you seek help?The correct answer is immediately. Seek help right away if you are short of breath, have chest pain, feel dizzy, lightheaded, sweaty, or if you just don't feel well. You should also see your doctor if your pulse is beating very fast or feels irregular, or if you have fainted. Even if your palpitations aren't bothering you, make an appointment with your doctor for a check-up.If you're having palpitations, does that mean you have a heart problem?The correct answer is maybe. Palpitations are a common symptom and are often not a sign of a heart problem. However, people with heart disease may be more likely to have problems that cause palpitations. Some of these heart problems include narrowed arteries in your heart (coronary artery disease), heart failure, abnormal heart valves, and abnormal heart rhythms (arrhythmia).Which other medical problems may cause heart palpitations?The correct answer is all of these can cause palpitations. An overactive thyroid can cause heart palpitations. So can a low blood count (or anemia) -- the heart may need to beat faster or harder when you have anemia. Medicines used for asthma, many cough and cold medicines, and other medicines may cause palpitations. During pregnancy, your heart works harder to pump more blood.Drinking too much caffeine may cause heart palpitations.The correct answer is true. Caffeine excites or stimulates the heart, causing it to beat faster and sometimes causing an extra beat.What else may cause heart palpitations?The correct answer is all of the above. Many people under stress may notice skipped or extra beats. Some cough and cold medicines cause palpitations, as can drugs such as cocaine or amphetamines. Herbs and supplements can also cause changes in your body, including both minor and severe palpitations.If you see a doctor for heart palpitations, will you need tests?The correct answer is maybe. Your doctor will talk to you and check your pulse, listen to your heart, and perhaps perform an electrocardiogram (ECG). He or she will ask how often you have palpitations, how long they last, and what other symptoms you have. Based on the results, you may need blood tests to check for anemia or thyroid problems. You may need a chest x-ray, echocardiogram, or need to wear a device for days or weeks that records your heart rate.What can you do at home to prevent palpitations?The correct answer is all of the above. It's important to get checked by your doctor. The tips mentioned above are steps you can take to help prevent or reduce the amount of palpitations you have. Reducing stress can help a lot. Take some time off, try some activities that you enjoy, and learn how to relax. If stress is a special concern, you may want to get extra support.

References

Curtis AB, Tomaselli GF. Approach to the patient with cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 61.

Fang JC, O'Gara PT. History and physical examination: an evidence-based approach. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Olgin JE. Approach to the patient with suspected arrhythmia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 49.

What to Expect at Your Office Visit

Your provider will examine you and ask questions about your medical history and symptoms.

You may be asked:

  • Do you feel skipped or stopped beats?
  • Does your heart rate feel slow or fast when you have the palpitations?
  • Do you feel a racing, pounding, or fluttering?
  • Is there a regular or irregular pattern to the unusual heartbeat sensations?
  • Did the palpitations begin or end suddenly?
  • When do the palpitations occur? In response to reminders of a traumatic event? When you are lying down and resting? When you change your body position? When you feel emotional?
  • Do you have any other symptoms?
  • Do you consume stimulant drugs (such as amphetamine or cocaine), caffeine or excessive alcohol?

An electrocardiogram may be done.

If you go to an emergency room, you will be connected to a heart monitor. However, most people with palpitations do not need to go to an emergency room for diagnosis and treatment.

If your provider finds you have an abnormal heart rhythm, other tests may be done. This may include:

When to Contact a Medical Professional

If you have never had heart palpitations before, see your provider.

Call 911 or the local emergency number if you have:

Contact your provider right away if:

  • You often feel extra heartbeats (more than 6 per minute or coming in groups of 3 or more).
  • You have heart disease or risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
  • You have new or different heart palpitations.
  • Your pulse is more than 100 beats per minute (without exercise, anxiety, or fever).
  • You have related symptoms, such as chest pain, shortness of breath, feeling faint, or loss of consciousness.

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