Heart Palpitations

Causes of heart palpitations

A range of health issues, medications and other substances can trigger heart palpitations. Some common causes include:

• Anxiety, stress and panic attacks
• Arrhythmias (conditions in which the heartbeat is irregular), such as ventricular tachycardia, ventricular fibrillation, atrial fibrillation and atrial flutter
• Caffeine, alcohol and nicotine
• Cocaine, methamphetamine and other stimulant drugs
• Certain medications, such as decongestants, drugs used in asthma inhalers, and vasodilators (most often used to treat high blood pressure)
• Fever
• Heart valve problems, including mitral valve prolapse
• Other medical issues, such as anemia, hyperthyroidism (an overactive thyroid gland) and hypoglycemia (low blood sugar)
• Pregnancy
• Withdrawal from beta-blockers, a type of drug used to treat high blood pressure and certain other conditions

In most cases, doctors are able to determine the cause of a patient's heart palpitations.

Symptoms of heart palpitations

How people experience heart palpitations varies. Many patients describe them as feeling like:

• Rapid fluttering in the chest
• Flip-flopping in the chest
• Pounding in the chest or neck
• A skipped heartbeat

During heart palpitations, people may also:

• Feel lightheaded
• Faint or feel as though they're about to faint

Diagnosis of heart palpitations

To learn what's causing your heart palpitations, your doctor will examine you and listen to your heart with a stethoscope. They will likely ask about your medical history as well as how you experience heart palpitations.

In particular, the doctor may ask:

• What do your heart palpitations feel like?
• When did you start having heart palpitations?
• How long do your heart palpitations last?
• Do the palpitations start and end suddenly or do they gradually build and fade?
• Do the palpitations occur when you're in a particular position or when you change positions?
• Do the palpitations occur during exercise?
• Do the palpitations occur when you're feeling anxious or stressed?
• Do you have a heart condition or a family history of heart disease?
• Do you have other medical conditions or any mental health issues, such as anxiety?
• What medications do you take?
• Do you consume caffeine; use nicotine; or take other drugs, such as amphetamines?

You may need to have an electrocardiogram (ECG), a painless test that records the heart's electrical activity. ECGs can help identify arrhythmias (irregularities in heart rhythm). You may also have a blood test to check for certain conditions that can cause heart palpations, such as anemia and hyperthyroidism.

Some patients need additional tests, such as:

• Echocardiogram. This noninvasive test uses sound waves (ultrasound) to create images that help doctors detect a structural problem with the heart.
• Holter monitors or cardiac event recorders. These wearable ECG devices are used to record heart activity in people with infrequent symptoms. Holter monitors are worn for one to two days while event recorders can be worn for weeks.
• Electrophysiology (EP) study. To evaluate abnormal heart rhythms, a catheter (a thin, flexible tube) is passed into a blood vessel to reach the heart and temporarily place electrodes that measure the heart's electrical activity.

You may be referred to a cardiologist for some of these tests or for treatment.

Treatment of heart palpitations

In many cases, heart palpitations are harmless and don't require treatment. But if a heart condition or other medical issue is causing your palpitations, your doctor will focus on treating the underlying cause. For instance:

• Arrhythmias. Medications or procedures (such as catheter ablation) may be used to treat arrhythmias.
• Other health conditions. If another health issue, such as hypoglycemia, is the only underlying cause, your doctor will try treating that issue first.
• Medications. If heart palpitations are a common side effect of a medicine you use, your doctor may discontinue that drug or otherwise adjust your medications.
• Anxiety. Anxiety and heart palpitations can create a feedback loop: Anxiety causes heart palpitations and heart palpitations cause anxiety. If your doctor can't identify what's triggering your heart palpitations or suspects anxiety is a factor, you may be referred to a mental health care provider for evaluation.

Lifestyle changes to prevent heart palpitations

Some people can prevent or reduce their heart palpitations by making lifestyle changes, such as:

• Managing stress and anxiety
• Avoiding or limiting triggers, such as caffeine, alcohol and nicotine
• Avoiding stimulant drugs, such as cocaine
• Getting regular exercise