Palpitations

Palpitations may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the heart may also involve other body systems. Some symptoms that may accompany palpitations may indicate a serious or life-threatening condition.

Palpitations may accompany symptoms related to other body systems including:

• Anxiety

• Coughing up clear, yellow, light brown, or green mucus

• Fever

• Indigestion

• Nausea with or without vomiting

• Rapid heart rate (tachycardia)

• Thirst

In some cases, palpitations may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have palpitations accompanied by any of these symptoms including:

• Chest pain or pressure

• Dizziness

• Fainting or change in level of consciousness or lethargy

• Lightheadedness

• Nausea with or without vomiting

• Pain in the back, neck, jaw or stomach

• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, choking

• Sweating

Palpitations causes range from mild to serious. Your healthcare provider will most likely perform diagnostic tests to determine the underlying cause of your palpitations.

Palpitations may be caused by a cardiovascular disorder or disease including:

• Cardiac arrhythmias (such as atrial fibrillation, supraventricular tachycardia, ventricular tachycardia)

• Cardiomyopathy (weakened or abnormal heart muscle and function)

• Coronary artery disease (commonly known as heart disease)

• Heart ischemia

• Heart valve disease

• Hypertension (high blood pressure)

• Mitral valve prolapse

Palpitations may be caused by gastrointestinal disorders including:

• Gallstones

• Gastroesophageal reflux disease (GERD)

• Indigestion

• Pancreatitis

• Peptic ulcers

Palpitations may be caused by mental health problems including:

• Anxiety and anxiety disorders

• Memory of a traumatic event

• Panic attack or panic disorders

• Stress

Palpitations may be caused by respiratory disorders including:

• Acute bronchitis

• Asthma

• Bronchiolitis

• Chronic obstructive pulmonary disease (COPD)

• Pneumonia

• Pneumothorax (collapsed lung)

• Pulmonary edema (buildup of fluid in the lungs)

• Pulmonary embolism

Palpitations may be caused by a variety of medications and substances including:

• Alcohol

• Amphetamines

• Coffee or any product containing caffeine

• Cold medications containing decongestants, such as ephedrine and pseudoephedrine

• Diet drugs

• Medications used to treat asthma, heart problems, high blood pressure, or thyroid disease

• Nicotine   

• Stimulants

• Street drugs, such as cocaine, ecstasy, LSD, marijuana and methamphetamine

Other causes of palpitations include:

• Anemia

• Exercise

• Fever

• Hypoglycemia (low blood sugar)

• Perimenopause

• Trauma

In some cases, palpitations may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

• Angina

• Aortic dissection (bleeding into the wall of the body’s main artery, the aorta)

• Heart attack (myocardial infarction)

• Heart failure

• Pericarditis (inflammation of the sac surrounding the heart)   

If you feel palpitations briefly on occasion, there is probably no immediate health concern. It is common to feel your heart skip or flutter every now and then. If the sensation is causing concern, make an appointment to see your doctor.

If you have palpitations frequently or they last more than a few minutes, seeing your doctor is the safest option to make sure there is no serious underlying cause.

See a doctor promptly (within a day or two) when:

• Palpitations persist, change or worsen.

• You feel more than six extra heartbeats in a minute or extra heartbeats happen in groups of three or more.

• You have a history of heart disease, high blood pressure, high cholesterol, or diabetes.

• Your pulse is higher than 100 beats per minute without exercising or without mental or physical stress.

Call 911 or go to your nearest emergency room for palpitations with other potentially serious symptoms including:

• Anxiety or unusual sweating

• Chest pain, discomfort or squeezing

• Dizziness or lightheadedness

• Feeling faint, changes in alertness, or loss of consciousness

• Pain that radiates to the jaw, neck, back, shoulder or arm

• Shortness of breath or difficulty breathing

To diagnose the cause of your palpitations, your doctor may ask you several questions including:

• How long have you been experiencing palpitations?

• Do you feel a regular or irregular pattern to your heartbeat?

• Do you feel that your heartbeat is stopping or skipping?

• Do the palpitations begin or end suddenly?

• When do the palpitations occur? Do they coincide with any specific activities?

• Do you have any other symptoms?

• What other medical conditions do you have?

• What medications are you taking?

Your doctor will perform a physical exam that will include listening to your heart. The exam will also focus on uncovering potential underlying causes of the palpitations, such as a thyroid gland or lung problem. As part of the exam, your doctor may perform a baseline ECG (electrocardiogram, or EKG). This test measures your heart’s electrical activity and can indicate the specific abnormality causing the palpitations.

Based on the results of your exam and medical history, your doctor may order additional testing. This may include:

• Blood tests, which can detect enzymes that are present during and after a heart attack

• Echocardiogram, which records moving and still images of your heart as it beats

• Holter monitor or other event recorder, which continuously records your heart’s activity. This can be useful when palpitations do not occur during a regular ECG. Depending on your situation, you may wear the device for as little as 24 hours or for several weeks or months.

• Stress test, which checks your heart’s response during exertion

• Intracardiac electrophysiology study (EPS), which is a catheter-based procedure to place electrodes inside the heart. It can help precisely locate any abnormal heart tissue causing the problem. It can also give your doctor important information about the best treatment.

• Coronary angiography, which is also a catheter-based procedure. It uses dye and X-rays to show how blood moves through your coronary arteries—the vessels that supply your heart muscle. It can detect problems with blood supply to your heart muscle.

It is not always possible to diagnose an underlying cause or condition for palpitations. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

If your doctor does not find a heart condition, your palpitations may not require treatment. In this case, reducing triggers will be the focus of managing them.

Doctors may recommend treating palpitations if they are very frequent or bothersome. Beta blockers are one prescription medication option to regulate the heartbeat. Cardiac ablation to interrupt errant electrical signals may also be an option for some people.

If a heart condition or other condition is causing palpitations, treatment will depend on the specific underlying cause. Correcting or managing physical or mental conditions may help resolve the palpitations. This may involve medications, procedures or surgery, such as cardiac ablation for an arrhythmia.

Managing triggers is often helpful in reducing palpitations. This involves lifestyle modifications including:

• Avoiding stimulants, including caffeine, nicotine, amphetamines and decongestants

• Getting regular physical activity, plenty of rest, and enough fluids to stay hydrated

• Limiting or stopping alcohol consumption

• Not smoking 

• Not using illegal drugs, such as cocaine or methamphetamine

• Reducing stress with relaxation techniques, such as breathing exercises, meditation, or mind-body exercises like yoga or tai-chi

Sometimes, low levels of minerals, such as potassium and magnesium, can contribute to palpitations. Talk with your doctor before using any kind of supplement to treat palpitations. Too much of these minerals can be dangerous.

Because palpitations can be caused by serious diseases, failure to seek treatment can result in serious or life-threatening complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare provider design specifically for you to reduce the risk of potential complications including:

• Adverse effects of treatment for palpitations

• Cardiac arrest

• Coma

• Difficulty breathing

• Heart failure

• Hypoxia (low levels of oxygen in the blood)

• Respiratory failure and respiratory arrest

• Stroke