heart palpitations (original) (raw)

Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Overview

Many things can trigger palpitations, including:

• Strong emotions
• Vigorous physical activity
• Medicines, such as diet pills and decongestants
• Caffeine, alcohol, nicotine, and illegal drugs
• Certain medical conditions, such as thyroid disease or anemia

These factors make the heart beat faster (see heart rate) or stronger than usual, or they cause occasional premature (extra) heartbeats. In these situations, the heart is still working normally, and the palpitations are usually harmless.

Sometimes palpitations are symptoms of arrhythmias. Arrhythmias are problems with the speed or rhythm of the heartbeat. Some arrhythmias are signs of heart disease, including heart attack, heart failure, heart valve problems, or heart muscle problems. However, less than half of the people who have palpitations have arrhythmias.

People can reduce or prevent palpitations by avoiding things that trigger them (such as stress and stimulants) and treating related medical conditions.

Outlook

Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can check to see whether you need treatment or ongoing care.

Causes

Many things can cause palpitations. You may feel palpitations even when your heart is beating normally or somewhat faster than normal. In these cases, nothing is wrong with your heart.

However, some palpitations are a sign of an actual heart problem. Sometimes, the cause of palpitations can't be found.

If you start having palpitations, you should see your doctor to have them checked out.

causes not related to heart problems

Strong emotions

You may feel your heart pounding or racing during anxiety, fear, or stress. You also may have these feelings if you're having a panic attack.

Vigorous physical activity

Intense activity can make it feel as though your heart is beating too hard or fast, even though it's working normally. It also may cause an occasional premature (extra) heartbeat.

Medical conditions

Certain medical conditions can cause palpitations. This is because they can make the heart beat faster or stronger or cause premature (extra) heartbeats. These conditions include:

• An overactive thyroid
• A low blood sugar level
• Anemia
• Some types of low blood pressure (hypotension)
• Fever
• Dehydration (not enough fluid in the body)

Hormonal changes

The hormonal changes that happen during pregnancy, menstruation, and the perimenopausal period can sometimes cause palpitations. These palpitations will likely improve or go away as these conditions go away or change.

Some palpitations that occur during pregnancy may be due to anemia.

Medicines and stimulants

A number of medicines can trigger palpitations because they can make the heart beat faster or stronger or cause premature (extra) heartbeats. These include:

• Asthma inhalers.
• Medicines to treat an underactive thyroid. (Too much thyroid replacement hormone, used to treat an underactive thyroid, can cause palpitations by causing an overactive thyroid.)
• Medicines to prevent arrhythmias. (Medicines used to treat these irregular heartbeats can sometimes cause other irregular heart rhythms.)

Over-the-counter medicines that act as stimulants also may cause palpitations. These include decongestants (found in cough and cold medicines) and some herbal or nutritional supplements.

Caffeine, nicotine (found in tobacco), alcohol, and illegal drugs (such as cocaine and amphetamines) also may cause palpitations.

Causes related to heart problems

Sometimes, palpitations are the symptoms of arrhythmias. Arrhythmias are problems with the speed or rhythm of the heartbeat. However, less than half of the people who have palpitations have arrhythmias.

During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. An arrhythmia happens when some part of the heart's electrical system doesn't work as it should.

Palpitations are more likely to be related to an arrhythmia if you:

• Have had a heart attack or are at risk for one.
• Have heart disease or risk factors for heart disease.
• Have other heart problems, such as heart failure, heart valve problems, or heart muscle problems.
• Have abnormal electrolyte levels. Electrolytes are minerals, such as potassium and sodium, found in blood and body fluids. They're vital for normal health and functioning of the body.

Who is at risk for palpitations

Some people may be more likely to have palpitations, including people who:

• Have anxiety, panic attacks, or are highly stressed
• Take certain medicines or stimulants
• Have certain medical conditions that aren't related to heart problems, such as an overactive thyroid.
• Have certain heart problems, such as arrhythmias (irregular heartbeats), a previous heart attack, heart failure, heart valve problems, or heart muscle problems.

Women who are pregnant, menstruating, or perimenopausal also may be at higher risk, because hormonal changes can cause palpitations. Also, some palpitations that occur during pregnancy may be due to anemia.

Signs and symptoms

Symptoms of palpitations include feelings that your heart is:

• Skipping a beat
• Fluttering
• Beating too hard or fast

You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Often, palpitations are harmless and your heart is working normally. Palpitations can be a sign of a more serious problem if you also:

• Feel dizzy or confused
• Are light-headed, think you may faint, or do faint
• Have trouble breathing
• Have pain, pressure, or tightness in your chest, jaw, or arm
• Feel short of breath
• Have unusual sweating

If your doctor has already told you that your palpitations are harmless, talk to him or her again if they:

• Start to occur more often or are more noticeable or bothersome
• Occur with other symptoms, such as those listed above

Your doctor will want to check whether your palpitations are the symptom of a heart problem, such as an arrhythmia (irregular heartbeat).

Diagnosis

Your doctor will first want to find out whether your palpitations are harmless or related to a more serious heart problem. To do this, he or she will ask about your symptoms and medical history, do a physical exam, and order several basic tests.

This information may point to a heart problem as the cause for your palpitations. If so, your doctor may recommend more tests. These will help show what the problem is and how to treat it.

The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.

Specialists involved

Several types of doctors may work with you to diagnose and treat your palpitations. These include a:

• Primary care doctor
• Cardiologist (a doctor who specializes in treating adults who have heart problems)
• Electrophysiologist; a cardiologist who specializes in the heart's electrical system)

Medical history

Your doctor will ask questions about your palpitations, such as:

• When did they begin?
• How long do they last?
• How often do they occur?
• Do they start and stop suddenly?
• Does your heartbeat feel steady or irregular during the palpitations?
• What other symptoms do you have when you get palpitations?
• Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?

Your doctor also will ask you about your use of caffeine, alcohol, supplements, and illegal drugs.

Physical exam

Your doctor will take your pulse to find out how fast your heart is beating and whether it's beating with a normal rhythm. He or she also will use a stethoscope to listen to your heartbeat.

Your doctor also may look for signs of other conditions (such as an overactive thyroid) that can cause palpitations.

Diagnostic tests

Often, the first test that's done is an EKG (electrocardiogram). This simple test records your heart's electrical activity. An EKG is used to detect and locate the source of heart problems. It shows how fast your heart is beating and whether its rhythm is steady or irregular. It records the strength and timing of electrical signals as they pass through each part of your heart.

Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, he or she will order blood tests to gather more information about your heart's structure, function, and electrical system.

Holter monitor

A Holter monitor records the electrical signals of your heart for a full 24- or 48-hr period. You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

During the 24- or 48-hour period, you do your usual daily activities. You keep a notebook and note any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.

Event monitor

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.

For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.

Event monitors can be worn for 1 to 2 mo, or as long as it takes to record your heart's activity during palpitations.

Echocardiography

Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart. It also shows your heart valves and how well they're working.

Stress test

Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.

Treatment

Treatment depends on the cause of the palpitations. Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed.

Avoiding triggers

Your palpitations may be harmless but bothersome. If so, your doctor may suggest avoiding things that trigger them. Your doctor may advise you to:

• Reduce anxiety and stress. Anxiety and stress, including panic attacks, are a common cause of harmless palpitations. Relaxation exercises, yoga or tai chi, biofeedback or guided imagery, or aromatherapy may help you relax.
• Avoid or limit stimulants, such as caffeine, nicotine, alcohol, or amphetamines.
• Avoid illegal drugs, such as cocaine.
• Avoid medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements.

Treating medical conditions that may cause palpitations

Your doctor will try to help you control medical conditions (such as an overactive thyroid) that can cause palpitations. If you're taking medicine that's causing the palpitations, your doctor will try to find a different medicine for you.

If your palpitations are due to an arrhythmia, your doctor may choose to treat it with medicines or procedures.

Prevention

You can take steps to prevent palpitations.

• Reduce anxiety and stress in your life.
• Avoid or limit stimulants, such as caffeine, nicotine, alcohol, and illegal drugs.
• Treat medical conditions that may lead to palpitations or arrhythmias (irregular heartbeats).

Living with palpitations

Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed. Your doctor may advise you to avoid triggers for palpitations.

Your doctor may have already told you that your palpitations are harmless. However, if they become very noticeable or bothersome, you should see your doctor again. You also should see your doctor if your palpitations get worse or begin to happen more often.

Your doctor will tell you about other signs and symptoms to be aware of and when to seek emergency care.

Your palpitations may be due to a medical condition or heart problem. If so, your doctor will give you advice and treatment for your condition.