Heart palpitations

Heart palpitations (pal-pih-TAY-shuns) are feelings of having a fast-beating, fluttering or pounding heart. Stress, exercise, medication or, rarely, a medical condition can trigger them.

Although heart palpitations can be worrisome, they’re usually harmless. Rarely, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that might require treatment.

Heart palpitations can feel like the heart is:

• Beating too fast
• Flip-flopping
• Fluttering rapidly
• Pounding
• Skipping beats

Heart palpitations may be felt in the throat or neck as well as the chest. They can occur during activity or at rest.

Palpitations that are infrequent and last only a few seconds usually don’t need to be evaluated. If you have a history of heart disease and have palpitations that occur frequently or worsen, talk to your health care provider. You may need heart-monitoring tests to see if the palpitations are caused by a more serious heart problem.

Seek emergency medical attention if heart palpitations occur with:

• Chest discomfort or pain
• Fainting
• Severe shortness of breath
• Severe dizziness

Often the cause of heart palpitations can’t be found. Common causes include:

• Strong emotional responses, such as stress, anxiety or panic attacks
• Depression
• Strenuous exercise
• Stimulants, including caffeine, nicotine, cocaine, amphetamines, and cold and cough medications that contain pseudoephedrine
• Fever
• Hormone changes associated with menstruation, pregnancy or menopause
• Too much or too little thyroid hormone

Occasionally heart palpitations can be a sign of a serious problem, such as an irregular heart rhythm (arrhythmia).

Arrhythmias might cause a very fast heartbeat (tachycardia), an unusually slow heartbeat (bradycardia), a heartbeat that varies from a typical heart rhythm or a combination of the three.

Risk factors for heart palpitations include:

• Stress
• Anxiety disorder or panic attack
• Pregnancy
• Certain medicines that contain stimulants, such as some cold or asthma medications
• An overactive thyroid gland (hyperthyroidism)
• Other heart problems, such as irregular heartbeats, structural heart changes, previous heart attack or previous heart surgery

For palpitations caused by a heart condition, possible complications may include:

• Fainting. If the heart beats rapidly, blood pressure can drop, causing the person to faint. This is more likely in those with a heart problem, such as congenital heart disease or certain valve problems.
• Cardiac arrest. Rarely, palpitations can be caused by life-threatening heartbeat problems and can cause the heart to stop beating effectively.
• Stroke. If palpitations are due to a condition in which the upper chambers of the heart quiver instead of beating properly (atrial fibrillation), blood can pool and cause clots to form. If a clot breaks loose, it can block a brain artery, causing a stroke.
• Heart failure. Certain arrhythmias can reduce the heart’s pumping ability. Sometimes, controlling the rate of an arrhythmia that’s causing heart failure can improve the heart’s function.

To diagnose palpitations, a health care provider will do a physical exam and listen to your heart using a stethoscope. The exam may include looking for signs of medical conditions that can cause heart palpitations, such as a swollen thyroid gland. You will likely be asked questions about your medical history.

If your doctor thinks that palpitations are caused by an irregular heartbeat or other heart condition, tests might include:

• Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too slow, too fast or not at all.
• Holter monitoring. This portable ECG device is worn for a day or more to record the heart’s rate and rhythm during daily activities. It’s used to detect heart palpitations that aren’t found during a regular ECG exam. Some personal devices, such as smartwatches, offer remote ECG monitoring. Ask your health care provider if this is an option for you.
• Event recording. If you don’t have irregular heart rhythms while you wear a Holter monitor or if the events occur less than once weekly, your health care provider might recommend an event recorder. You press a button when symptoms occur. An event recorder is typically worn for up to 30 days or until you have an arrhythmia or symptoms.
• Echocardiogram. This noninvasive exam uses sound waves to create moving pictures of the heart in motion. It can show blood flow and structure problems with the heart.

Unless the palpitations are caused by a heart condition, heart palpitations rarely require treatment. Instead, a health care provider might recommend taking steps to avoid the triggers that cause palpitations.

If palpitations are caused by a heart condition, such as an irregular heartbeat (arrhythmia), treatment will focus on correcting the condition.

The most appropriate way to treat palpitations at home is to avoid the triggers that cause the symptoms.

• Reduce stress. Try relaxation techniques, such as meditation, yoga or deep breathing.
• Avoid stimulants. Caffeine, nicotine, some cold medicines and energy drinks can make the heart beat too fast or irregularly.
• Avoid illegal drugs. Certain drugs, such as cocaine and amphetamines, can cause heart palpitations.

If you have heart palpitations with severe shortness of breath, chest pain or fainting, seek emergency medical attention.

If your palpitations are brief and there are no other worrisome signs or symptoms, make an appointment to see your health care provider. A health care provider can help determine if palpitations are harmless or a symptom of a more serious heart condition. You may be referred to a doctor who specializes in heart diseases (cardiologist).

Here’s some information to help you get ready for your appointment:

What you can do

When you make the appointment, ask if there’s anything you need to do in advance, such as restrict your diet.

Make a list of:

• Your symptoms, including any that seem unrelated to heart palpitations, and when they began
• Key personal information, including family history of heart disease, arrhythmias, stroke, high blood pressure or diabetes, as well as major stresses or recent changes in your life
• All medications, vitamins and supplements you take, including doses
• Questions to ask your health care provider

Take a family member or friend along, if possible, to help you remember the information you’re given.

For heart palpitations, basic questions to ask your health care provider include:

• What is likely causing my symptoms or condition?
• What are other possible causes?
• What should I do if my symptoms return?
• What tests will I need?
• Do I need treatment and, if so, what?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• Do you always have palpitations or do they come and go?
• Do the palpitations start and stop suddenly?
• Do the palpitations seem to occur at the same time every day or during a certain activity?
• What, if anything, seems to improve symptoms?
• What, if anything, appears to worsen symptoms?
• Are you having other symptoms such as shortness of breath, chest pain, fainting or dizziness when you have palpitations?
• Do you have a history of heart rhythm problems, such as atrial fibrillation?

What you can do in the meantime

Before your appointment, you can try to improve your symptoms by avoiding stress or activities that might cause palpitations. Some common triggers include:

• Anxiety or panic attacks
• Too much caffeine or alcohol
• Use of medications or supplements that contain stimulants, such as energy drinks or some cold medicines