Heart Palpitations: How Common Are They and Should You Worry?
Frequently Asked Questions
Does your heart skip a beat when your true love walks in the door? This could be more than true love. Heart palpitations can be serious. Maribel Hernandez, MD, Lankenau Medical Center electrophysiologist, explains why.
What are heart palpitations?
Heart palpitations are a sensation that your heart is beating faster than normal or seems to be skipping or stopping a beat. You may hear them referred to by various names, including heart pounding, heart racing, or a rapid heart rate.
What do palpitations feel like?
Patients describe palpitations in various ways-from just being aware of your own heartbeat to a relentless pounding. You may experience racing, fluttering, or a flip-flopping in the chest. You can feel palpitations in your chest, throat, or neck.
Do palpitations mean I have an abnormal heart rhythm?
Not necessarily. Many people experience heart palpitations at one time or another. Mostly, they're benign, lasting a few seconds, and don't signify an abnormal rhythm, known as an arrhythmia. You're more likely to have an abnormal heart rhythm if you have heart disease or significant risk factors for heart disease, or a structural problem with the heart, such as an abnormal heart valve.
What causes palpitations?
There are numerous causes for palpitations, ranging from stress to medications to heart disease. The National Institutes of Health has a long list of some of the common reasons palpitations develop:
Anxiety, stress, or fear
Caffeine, nicotine, cocaine, diet pills
Low levels of oxygen in your blood
Medications, such as thyroid pills, asthma drugs, and beta blockers for high blood pressure or heart disease
Mitral valve prolapse
Diseases of the heart muscle, valves, or coronary arteries
What's the connection between perimenopause and heart palpitations?
Heart palpitations often accompany hot flashes and may increase your heart rate by 8 to 16 beats per minute. Generally, they're considered to be the result of fluctuating hormones and go away in a few months as your hormones stabilize. After hot flashes, palpitations are the second most common complaint associated with perimenopause, and they can be scary. The chest pounding commonly occurs when you're lying in bed.
When should I see a doctor for my heart palpitations?
If your heart palpitations are new, you should certainly bring them to the attention of your primary care physician. Your doctor will do a work-up to determine the cause and treatment, if necessary. Depending on what your doctor finds, you may be referred to an electrophysiologist, a specialist in heart rhythm disorders and the heart's electrical system.
That said, there are times when you should seek medical help right away:
Call your doctor if your palpitations are different than ones you've had before, you feel frequent extra heartbeats, you have risk factors for heart disease, or your pulse is more than 100 beats per minute-unaccompanied by a fever, anxiety, or exercising.
Call 911 if your palpitations are accompanied by shortness of breath, severe chest pain, unusual sweating, dizziness, or lightheadedness, or if you almost pass out or lose consciousness.
In general, the seriousness of the palpitations is in proportion to the symptoms. Shortness of breath and severe chest pain call for an extensive, immediate evaluation. A sensation of fluttering is less worrisome. Mild chest discomfort is very common with palpitations.
How are heart palpitations diagnosed?
The first step in any diagnosis is to take a medical history-how long you've had the symptoms, how often, any recent illnesses, surgeries, and medications. We follow that with a general examination and blood tests to measure levels of sodium, potassium, calcium, magnesium, and other elements. In most cases, this basic evaluation is enough to determine if your palpitations are benign or warrant further testing.
If your symptoms are more severe, such as lightheadedness associated with your palpitations, several diagnostic tests are available. These include:
An electrocardiogram to record the electrical activity of your heart.
Holter monitoring, a take-home device that records all of your heart's activities over 24 hours.
Event monitoring, another type of take-home device that you activate only when you feel palpitations.
An echocardiogram to provide a picture of your heart's structures, such as an abnormal valve.
A stress test to detect arrhythmias that occur during exercise.
An electrophysiology study to map your heart's rhythms and show how it reacts to electrical signals.
Cardiac angiography to measure the blood flow and blood pressure in the heart's chambers.
Explain the connection between heart palpitations and the heart's electrical system?
The heart has a sophisticated electrical system of pathways that stimulate it to pump blood to other parts of the body. If the normal electrical pattern is disrupted for any reason, you may experience palpitations or other more serious rhythm disturbances. Some people are born with problems in their electrical pathways; others develop problems later in life as part of the aging process.
What are some of the serious conditions that heart palpitations can signal?
Two arrhythmias to be concerned about are atrial fibrillation and ventricular tachycardia. If these arrhythmias are present, it's important to determine their cause and treat them aggressively.
Atrial fibrillation is a rapid heartbeat that originates in the atria, the heart's upper chambers. It has numerous causes, including heart attack, high blood pressure, heart failure, mitral valve diseases, and an overactive thyroid. The danger of atrial fibrillation is that it can lead to stroke.
Ventricular arrhythmias originate in the heart's lower chambers and are life-threatening. They cause the heart to quiver, and can lead to sudden death, or cardiac arrest, within minutes. Ventricular arrhythmias are most commonly caused by heart attack or scarring of the heart from a previous heart attack
How do I manage heart palpitations?
Most palpitations need no treatment, but there are some things you can do on your own. You can avoid stimulants, such as alcohol, caffeine, tobacco, diet pills, and stress. In fact, caffeine is the most common substance associated with palpitations. Other lifestyle changes that are beneficial include exercise, controlling blood pressure, keeping normal cholesterol levels, and managing stress levels.
If your palpitations result from a serious underlying condition, however, your doctor has several options: medications, including beta blockers, to normalize the heart rate, and various surgical procedures and devices.
For example, we can destroy abnormal electrical pathways by delivering a burst of energy to the targeted area. The procedure is called catheter ablation. And if you have a life-threatening ventricular arrhythmia, we can implant an automatic defibrillator in your chest that delivers an electrical impulse when it senses an oncoming fibrillation to keep your heart beating regularly.
For more information, call 1.866.CALL.MLH.