What are heart palpitations?

Heart palpitations come on quickly and make it feel like your heart is pounding or racing. They may feel like you have exercised or they may feel like a flutter, a skipped or extra beat, or a heartbeat that simply does not feel normal. You may feel palpitations in your chest, throat or neck.

Palpitations can happen at any time, even if you are resting or doing normal daily activities. Although they may be startling, palpitations may or may not be related to an abnormal heart rate and are often not serious or harmful.

What causes heart palpitations?

Heart palpitations may be caused by:

  • Emotions, such as anxiety, stress, fear and panic
  • Exercise
  • Pregnancy
  • Caffeine found in coffee, teas, chocolate, colas, some sports drinks and foods
  • Medical conditions such as an overactive thyroid, low blood sugar, low potassium level, low oxygen level or low carbon dioxide level in the blood, fever, anemia, dehydration, loss of blood and shock
  • Medications such as asthma inhalers and decongestants, beta blockers (taken for high blood pressure or heart disease), thyroid and antiarrhythmic medications. Over-the-counter medications, that act as stimulants, such as cough and cold medicines, can also cause palpitations, as can some herbal and nutritional supplements
  • Illegal street drugs such as cocaine and amphetamines (speed)
  • Nicotine found in tobacco products
  • Symptoms of palpitations are more likely to be related to an abnormal heart rhythm if you have:
    • Significant risk factors for heart disease
    • Heart disease
    • Heart rhythm problems (irregular/abnormal heartbeat or arrhythmia)​
    • Abnormal heart valve
  • Are palpitations a symptom of a more serious health problem?

Palpitations may be a sign of a more serious health problem if you also feel:

  • Dizzy
  • Confused
  • Light-headed
  • Have trouble breathing
  • Pass out when you have palpitations

Call your doctor right away if you have these symptoms or if you also have pain, pressure, or tightness in your chest, neck, jaw, arms, or upper back; shortness of breath; unusual sweating; or if you have symptoms that are new or become worse.

How are palpitations diagnosed?

It may be difficult for your doctor to figure out the cause of your palpitations, especially if you don’t have palpitations during your visit. Sometimes, the cause is not known.

Keep track of your heart palpitations. Note when they happen, how long they last, how you feel and what you are doing when they start. Share this information with your doctor.

To help your doctor understand the cause of your symptoms, he or she will review your medical history, symptoms, diet, and medications and herbal products you take. Your doctor will also listen to your heart and lungs.

You may need tests, such as blood and urine tests, electrocardiogram (ECG/EKG), stress test, chest X-ray and echocardiogram (heart ultrasound). Some patients need to wear a monitor to record their heartbeat for an extended period of time. If your doctor thinks you may have a heart problem, you may have more invasive tests, such as an electrophysiology study or cardiac catheterization. Your doctor may refer you to an electrophysiologist, who specializes in abnormal heart rhythms.

What treatments are available for patients with heart palpitations?

You may not need any treatment for your palpitations. If the palpitations are related to certain foods or activities, you should avoid those triggers. The type of treatment that is best is based on the cause of the palpitations. If your doctor determines that you have heart disease or an abnormal heart rhythm, you may need medication, an invasive treatment, surgery or a device to correct the problem. It is important to keep all follow-up appointments with your doctor.

If you notice a sudden increase or change in the palpitations, call your doctor.

What can I do to prevent palpitations?

You can help prevent heart palpitations by taking the following steps:

  • Decrease your stress level (learn biofeedback, deep breathing and/or relaxation exercises such as yoga, tai chi or guided imagery)
  • Avoid or limit the amount of alcohol you drink
  • Avoid or limit caffeinated beverages
  • Do not smoke or use tobacco products
  • Exercise on a regular basis (Ask your doctor about the best exercise program for you)
  • Avoid foods and activities that trigger palpitations
  • Avoid certain medications and supplements that act as stimulants
  • Make sure your blood pressure and cholesterol are well-controlled
  • Try not to pay attention to your heart palpitations once any serious causes have been ruled out

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