What Causes Heart Palpitations?

What Are Heart Palpitations?  

Normally, the heart beats 60 to 100 times per minute with a regular pattern. A heart rate of less than 60 is called bradycardia. A heart rate of more than 100 is called tachycardia—a heart palpitation is when you can feel your heartbeat in a regular or irregular pattern.

In other words, heart palpitations are feelings of unusual heartbeat sensations, usually described as skipping beats or feeling like your heart is pounding or racing. Although the unpleasant awareness of your heartbeat can be worrisome, palpitations are not usually dangerous. Oftentimes, palpitations occur as a result of strenuous exercise, fever, and caffeine or nicotine intake. Common health conditions like high blood pressure and high cholesterol can also cause heart palpitations, which can be alleviated by controlling these conditions. However, sometimes heart palpitations can be related to more serious conditions that need to be treated, such as an irregular heart rhythm. 

Are Heart Palpitations Common?

Yes, heart palpitations are very common. Studies have found that 16% of patients seek care from their primary care providers for heart palpitations.  Heart palpitations are also one of the most common symptoms for which people see a cardiologist or heart specialist.

What Do Heart Palpitations Feel Like?

Different people experience different heart palpitations symptoms. For some people, it can feel like a heart pounding. Others describe palpitations as fluttering, flip-flopping, or throbbing. Palpitations can also feel like the heart is racing, having extra heartbeats, or skipping beats. 

Many people simply describe palpitations as a general feeling of unease. The abnormal sensations of the heart’s rhythm can be felt in the chest, throat, or neck. 

What Causes Heart Palpitations?

Most of the time, palpitations are not serious. An occasional extra heartbeat is nothing to worry about. Various things like panic attacks, fear, caffeine intake, and cocaine use can cause palpitations. Some of the common causes of heart palpitations include:

• Strenuous exercise

• Fever

• Nicotine intake

• Caffeine intake

• Alcohol intake

• Stress, anxiety, and fear, such as during panic attacks

• Pregnancy

• Spicy or rich food

• Medical conditions like overactive thyroid gland (too much thyroid hormone in the body)

• Low blood sugar

• Abnormal blood level of certain electrolytes, for example, low blood potassium

• Low blood oxygen

• Anemia

• Blood loss

• Dehydration

• Cocaine and other stimulant drugs

• Decongestant medications, cough and cold medicines, pseudoephedrine, diet pills, beta blockers, asthma inhalers, antiarrhythmic medications, and thyroid drugs

• Certain herbal products and nutritional supplements

However, palpitations can also result from cardiac arrhythmias (abnormal heart rhythms), where the heart muscle does not beat at a regular rate and rhythm. These are more serious and potentially life-threatening. Anyone with a suspected arrhythmia should be evaluated by a specialist in cardiovascular medicine. 

There are different types of irregular heartbeat, such as: 

• Atrial fibrillation (most common)

• Premature ventricular contractions

• Supraventricular tachycardia

Your cardiologist can diagnose the exact type of arrhythmia based on blood tests, electrocardiogram, echocardiogram, Holter monitor (heart monitor), cardiac catheterization, and other tests.

Signs and Symptoms of Heart Palpitations  

Symptoms and signs of heart palpitations include being aware of your own heartbeat or a heartbeat that feels unusual or uncomfortable. You can feel this abnormal heartbeat in your chest, neck, or throat. Heart palpitations can make your heartbeat feel like your:

• Heart racing or beating very fast

• Heart beating irregularly

• Heart skipping beats or having extra beats (ectopic beats)

• Heart thumping or pounding

• Heart fluttering

Heart palpitations typically last only a few seconds to minutes but can sometimes last longer. The episodes can occur frequently or occasionally, depending on exposure to triggers such as tension and anxiety.

What Can Be Mistaken for Heart Palpitations?  

Occasional heart palpitations that occur during periods of emotional or physical stress are not something you should worry about. However, it can be difficult to distinguish harmless palpitations from other more serious heart conditions, such as an irregular heart rhythm. An irregular heartbeat can be a sign of an abnormal heart rhythm that needs to be treated. Consult with your doctor if you have frequent episodes where your heart beats too fast, too slowly, or irregularly.

Risk Factors and Complications

The following conditions increase your risk of having an abnormal heart rhythm:

• Known heart disease.

• Significant risk factors for heart disease.

• Abnormal heart valves, such as aortic stenosis or mitral valve prolapse.

• Electrolyte abnormalities, such as abnormal blood levels of potassium. 

• Certain medicines, such as those used to treat asthma, heart disease, and high blood pressure. 

• Overactive thyroid.

• Low level of blood oxygen.

Complications of untreated heart arrhythmia include blood clots, stroke, heart failure, cardiac arrest, and sudden cardiac death.

Can You Have Heart Palpitations For No Reason?

Yes, you can have heart palpitations for no apparent reason. Palpitations begin suddenly and can occur at any time of the day or night in any body position. They can occur during activity or at rest. 

Anyone can develop heart palpitations, but they are more common in women. Palpitations can occur during certain stages of life, such as teenage years, during pregnancy, or around menopause.

The best way to prevent palpitations is to lead a heart-healthy lifestyle, including a balanced diet, regular exercise, healthy body weight, and management of risk factors for heart disease, such as high blood pressure, high blood sugar, and high cholesterol.

When Should I Worry About Heart Palpitations?  

Heart palpitations are usually not something to worry about. However, they can be a symptom of heart problems. You should seek evaluation and medical treatment if with palpitations you have other symptoms like:

• Dizziness or lightheadedness.

• Fainting.

• Confusion.

• Chest pain or pressure.

• Shortness of breath.

• Excessive sweating.

• Worsening heart flutters or more frequent palpitations.

• An extra beat more than 5-6 times per minute or in groups of 3 or more.

You should call your healthcare provider if you experience palpitations and have a medical history of heart disease or risk factors for heart disease, such as high blood pressure or high cholesterol.

If your abnormal heart rhythm does not stop or you experience loss of consciousness, chest pain, unusual sweating, trouble breathing, or shortness of breath, call 911 or your local emergency number.

Treatment and Management Strategies 

How Can I Fix My Heart Palpitations?

If you do not have an underlying health condition, you can take steps to reduce or stop heart palpitations by avoiding the triggers that cause your palpitations. The following self-care measures can help to reduce heart palpitations:

• Reduce stress through relaxation techniques such as yoga, meditation, and deep breathing exercises.

• Avoid stimulants such as nicotine, caffeine, and energy drinks.

• Avoid recreational drug use. Illegal drugs such as amphetamine and cocaine can trigger heart palpitations.

• Review medications with a health care provider. Some over-the-counter cold remedies can cause your heart to beat too fast or irregularly.

Medical Treatments and Therapeutic Options  

If a medical evaluation reveals a mental health issue, such as generalized anxiety or panic disorder, as the cause of your heart palpitations, you may be offered treatment options for your mental health. These options could include psychological counseling, such as talk therapy and antidepressants, to help ensure that your anxiety is well-managed. 

If the tests reveal that your heart palpitations are caused by a heart condition, you will require treatment from a health care provider, likely a cardiologist (a doctor who specializes in conditions of the heart) or an electrophysiologist (a cardiologist who specializes in heart rhythm disorders). 

Treatment for heart arrhythmias depends on the type of heart rhythm irregularity (for example, if the abnormal electrical signals start in the atrium (the heart’s upper chambers) or ventricle (the heart’s lower chambers) of the heart. Not all heart arrhythmias require treatment. Your healthcare provider may recommend regular checkups to monitor your heart without prescribing any specific treatment. 

However, some heart arrhythmias need to be treated because they cause severe symptoms or increase the risk of other serious heart problems. Treatment for heart arrhythmias can include: 

• Medicines to control a fast heart rate

• Blood thinners to prevent blood clots

• Treatments such as vagal maneuvers and cardioversion

• Surgical procedures such as catheter ablation and pacemaker placement

Diagnosing Heart Arrhythmias

Your doctor may order tests to diagnose a potential heart arrhythmia, including a chest X-ray, electrocardiogram (ECG or EKG), echocardiogram (Echo), Holter monitor, event recorder, or implantable loop recorder. You may also undergo tests such as a stress test, tilt table test, and electrophysiological (EP) mapping.

How Can I Prevent Heart Palpitations?

Here are some tips to limit palpitations: 

• Maintain good mental health. Yoga, tai-chi, deep breathing exercises, guided meditation, and physical exercise are all good ways to control stress levels with deep relaxation. 

• Avoid or limit caffeine, alcohol, and nicotine use.

• Avoid activities and foods that trigger palpitations.

• Control your blood pressure and cholesterol levels under control to lower your risk of heart attack and heart disease risk.

• However, when the cause is a disease, the most important thing is to be monitored by a cardiologist. Make sure to follow your treatment plan closely by taking your medications exactly as prescribed and attending regular check-ups and blood tests with your doctor.