What Are Palpitations?
Palpitations (pal-pi-TA-shuns) 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 youre 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
(uh-NEE-me-eh)
These factors make the heart beat faster 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
(ah-RITH-me-ahs). 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
arent 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.
What Causes Palpitations?
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 cant 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 youre
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
- 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 hearts electrical system doesnt 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:
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.
For more information about these risk factors, see
What Causes Palpitations?
What Are the Signs and Symptoms of
Palpitations?
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 youre 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 lightheaded, 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).
How Are Palpitations Diagnosed?
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 dont 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 (e-LEK-tro-fiz-e-OL-o-jist; a
cardiologist who specializes in the hearts 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? (See What Are the Signs and
Symptoms of 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 its 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 thats done is an
EKG
(electrocardiogram). This simple test records your hearts 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 thats causing palpitations. If your doctor
suspects this is the case, he or she will order blood tests to gather more
information about your hearts structure, function, and electrical
system.
Holter Monitor
A
Holter
monitor records the electrical signals of your heart for a full 24- or
48-hour 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.
Holter or Event Monitor
Figure A shows how a Holter or event
monitor attaches to a patient. In this example, the monitor is clipped to the
patients belt and electrodes are attached to his chest. Figure B shows an
electrocardiogram strip, which maps the data from the Holter or event
monitor.
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 hearts electrical activity at certain times
while youre 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 months, or as
long as it takes to record your hearts 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.
How Are Palpitations Treated?
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
youre taking medicine thats 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. For more
information, see the Diseases and Conditions Index
Arrhythmia
article.
How Can Palpitations Be Prevented?
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. (See How
Are Palpitations Treated?)
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.
Key Points
- 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.
- Palpitations are very common. They usually aren't
serious or harmful, but they can be bothersome.
- Strong emotions, vigorous physical activity,
medicines, stimulants, and some medical conditions can cause harmless
palpitations.
- 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.
- In some cases, the cause of palpitations can't be
found.
- Symptoms of palpitations include feelings that
your heart is skipping a beat, fluttering, or beating to hard or fast.
Palpitations may be a sign of a serious heart problem if you also feel dizzy or
confused; are lightheaded, 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; or have unusual sweating.
- 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 they get worse, begin to happen more often, or occur with other
symptoms.
- Your doctor will want to find out whether your
palpitations are harmless or related to a heart problem. To do this, he or she
may ask about your symptoms and medical history, do a physical exam, and order
several basic tests.
- Treatment depends on the cause of the
palpitations. Most palpitations are harmless and go away on their own. Your
doctor may advise you to avoid things that trigger them. If you have a medical
condition that causes palpitations, your doctor will treat you for that
condition.
- You can take steps to prevent palpitations.
Reduce anxiety and stress in your life. Avoid or limit stimulants. Treat
medical conditions that may lead to palpitations.
Links to Other Information About Palpitations
NHLBI Resources
Non-NHLBI Resources
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