Palpitations make you feel like your heart is beating too hard or too fast, skipping a beat, or fluttering. You may notice heart palpitations in your chest, throat, or neck.
They can be bothersome or frightening. They usually aren't serious or harmful, though, and often go away on their own. Most of the time, they're caused by stress and anxiety, or because you’ve had too much caffeine, nicotine, or alcohol. They can also happen when you’re pregnant.
In rare cases, palpitations can be a sign of a more serious heart condition. If you have heart palpitations, see your doctor. Get immediate medical attention if they come with:
- Shortness of breath
- Dizziness
- Chest pain
- Fainting
After your doctor takes your medical history and looks you over, they may order tests to find the cause. If they find one, the right treatment can reduce or get rid of the palpitations.
If there’s no underlying cause, lifestyle changes can help, including stress management.
Causes
There can be many. Usually, palpitations are either related to your heart or the cause is unknown. Non-heart-related causes include:
- Strong emotions like anxiety, fear, or stress. They often happen during panic attacks.
- Vigorous physical activity
- Caffeine, nicotine, alcohol, or illegal drugs such as cocaine and amphetamines
- Medical conditions, including thyroid disease, a low blood sugar level, anemia, low blood pressure, fever, and dehydration
- Hormonal changes during menstruation, pregnancy, or just before menopause. Sometimes, palpitations during pregnancy are signs of anemia.
- Medications, including diet pills, decongestants, asthma inhalers, and some drugs used to prevent arrhythmias (a serious heart rhythm problem) or treat an underactive thyroid
- Some herbal and nutritional supplements
- Abnormal electrolyte levels
Some people have palpitations after heavy meals rich in carbohydrates, sugar, or fat. Sometimes, eating foods with a lot of monosodium glutamate (MSG), nitrates, or sodium can bring them on, too.
If you have heart palpitations after eating certain foods, it could be due to food sensitivity. Keeping a food diary can help you figure out which foods to avoid.
They can also be related to heart disease. When they are, they’re more likely to represent arrhythmia. Heart conditions tied to palpitations include:
- Prior heart attack
- Coronary artery disease
- Heart failure
- Heart valve problems
- Heart muscle problems
At the Doctor’s Office
Your doctor will:
- Give you a physical exam
- Take down your medical history
- Want to know about your current medications, diet, and lifestyle
- Ask for specifics about when, how often, and under what circumstances your palpitations occur
Sometimes, a blood test can help your doctor find the cause of your palpitations. Other useful tests include:
Electrocardiogram(EKG): This can be done while you’re at rest or exercising. The latter is called a stress EKG. In both cases, the test records your heart's electrical signals and can find unusual heart rhythms.
Holter monitoring: You’ll wear a monitor on your chest. It continuously records your heart's electrical signals for 24 to 48 hours. It can identify rhythm differences that weren't picked up during an EKG.
Event recording: You’ll wear a device on your chest and use a handheld gadget to record your heart's electrical signals when symptoms occur.
Chest X-ray: Your doctor will check for changes in your lungs that could come from heart problems. For example, if they find fluid in your lungs, it may come from heart failure.
Echocardiogram: This is an ultrasound of your heart. It provides detailed information about its structure and function.
If necessary, your doctor may refer you to a cardiologist for more tests or treatment.
Treatment
This depends on their cause. Often, palpitations are harmless and go away on their own. In that case, no treatment is needed.
If your doctor doesn't find a cause, they may advise you to avoid the things that might trigger the palpitations. Strategies may include:
Ease anxiety and stress. Leave a stressful situation and try to be calm. Anxiety, stress, fear, or panic can cause palpitations. Other common ways to stay calm include:
- Relaxation exercises
- Yoga
- Tai chi
- Biofeedback
- Guided imagery
- Aromatherapy
Cut out certain foods, beverages, and other substances. These may include:
- Alcohol
- Nicotine
- Caffeine
- Illegal drugs
Avoid medications that act as stimulants. You may have to steer clear of:
- Cough and cold medicines
- Certain herbal and nutritional supplements
If lifestyle changes don’t help, you may be prescribed medications. In some cases, these will be beta-blockers or calcium-channel blockers.
If your doctor finds a reason for your palpitations, they will focus on treating that reason.
If they’re caused by a medication, your doctor will try to find a different treatment.
If they represent an arrhythmia, you may get medications or procedures. You may also be referred to a heart rhythm specialist known as an electrophysiologist.
Follow Up
Make sure to check in with your doctor. Often, palpitations aren’t serious, but they can be related to abnormal heart valves, heart rhythm problems, or panic attacks.
Always call a doctor if palpitations change in nature or increase suddenly.
Call 911 right away if you have these symptoms along with palpitations:
- Dizziness
- Confusion
- Lightheadedness
- Passing out
- Shortness of breath
- Pain, pressure, or tightness in the chest, neck, jaw, arms, or upper back
