Experiencing heart palpitations can be unsettling. It’s that strange feeling of your heart racing, fluttering, or pounding in your chest. People often describe it in different ways, sometimes as if “my heart stops” for a moment, or like a “flip-flopping” sensation. It can feel like a strong pulse throughout your chest, head, and neck, something you can compare your heart pounding to a drum beating too fast or a butterfly fluttering erratically in your chest. Sometimes, it’s just a general feeling of unease. In rarer cases, palpitations might even be linked to dizziness or fainting.
What Could Be Causing My Heart To Pound?
Many factors can trigger heart palpitations. Let’s explore some common culprits:
Diet and Drinks: Are They Making Your Heart Race?
One of the most common triggers is caffeine. Some people are highly sensitive to even small amounts of stimulants. The rise in popularity of espresso-based drinks like cappuccinos and lattes in the 1990s seemed to coincide with an increase in caffeine-related palpitations. If you’re experiencing palpitations, try reducing or cutting out caffeine from your diet by limiting coffee, soda, and energy drinks.
Chocolate is another dietary item that can cause palpitations in some individuals, especially when consumed in large quantities. Similarly, alcoholic beverages, particularly during holidays or times of increased alcohol consumption, can also lead to heart palpitations.
Medications: Over-the-Counter Triggers
Be mindful of over-the-counter medications, especially cold and allergy remedies. Many of these contain decongestants like pseudoephedrine, which can often trigger palpitations as a side effect. Always check the labels of your medications and consider decongestant-free alternatives if palpitations are a concern.
Lifestyle and Other Factors
Often, palpitations appear without any immediately obvious cause. However, factors like fatigue, stress, and lack of sleep are known to contribute to or worsen palpitations. Managing stress, ensuring adequate rest, and maintaining a healthy sleep schedule can be beneficial in reducing the frequency and intensity of heart palpitations.
How Will a Doctor Figure Out Why My Heart Is Pounding?
When you see a doctor about palpitations, the evaluation usually begins with a detailed discussion of your medical history and lifestyle. This includes questions about your diet, beverage intake, and any over-the-counter medications you’re taking. A thorough physical examination, focusing on your heart and lungs, will follow.
Diagnosing Palpitations: Initial Steps
For most cases of palpitations, which are often benign, the initial diagnostic steps are quite straightforward. They typically involve:
- Detailed Medical History and Physical Exam: As mentioned above, this helps identify potential triggers and assess your overall health.
- Electrocardiogram (ECG): This simple and painless test records the electrical activity of your heart and can detect any rhythm irregularities.
- Basic Blood Work: Routine blood tests may be ordered to check for underlying conditions that could contribute to palpitations.
Alt Text: ECG graph paper showing heartbeat rhythm, illustrating a heart rate test result for cardiac examination.
When Palpitations Need a Deeper Look
If your palpitations are accompanied by more concerning symptoms, such as significant dizziness, lightheadedness, or even loss of consciousness, a more comprehensive evaluation is necessary. This might include:
- Echocardiogram (Ultrasound of the Heart): This imaging test uses sound waves to create pictures of your heart, allowing doctors to assess its structure and function.
- Treadmill Exercise Test: This test monitors your heart’s activity while you exercise, helping to identify palpitations that occur during physical exertion.
- Advanced Blood Tests: More specialized blood tests, including thyroid function tests, may be ordered to rule out specific medical conditions.
- Ambulatory ECG Monitoring (Holter Monitor): This involves wearing a portable ECG device for 24-48 hours (or longer) to continuously monitor your heart rhythm and capture palpitations as they occur in your daily life.
In some rare instances, if a serious heart condition is suspected, more invasive studies might be required to get a definitive diagnosis.
Palpitations and Shortness of Breath: Should I Be Worried?
It’s not uncommon to experience both heart palpitations and shortness of breath simultaneously, even without a serious underlying condition. However, the combination of these symptoms can indicate that the heart rhythm irregularity is more significant and might warrant a more thorough medical evaluation.
Generally, the more severe the accompanying symptoms – such as dizziness, fainting, chest pain, or shortness of breath – the more seriously you should take the problem. If you experience palpitations along with any of these symptoms, it’s important to seek medical attention promptly.
For individuals with known heart conditions, such as a history of heart attack (myocardial infarction), congestive heart failure (CHF), or hypertrophic cardiomyopathy (HCM), palpitations should always be evaluated thoroughly. In these cases, palpitations may be a sign of a more serious underlying issue.
Are There Health Risks Associated With Heart Palpitations?
In most cases, the irregular heart rhythm itself doesn’t cause direct damage to the heart. However, persistent and very rapid heart rhythms over extended periods can, in some instances, lead to heart enlargement and heart failure.
Atrial fibrillation, a common cause of palpitations characterized by a rapid and irregular heartbeat, can sometimes lead to heart enlargement. While many people can live with atrial fibrillation for years without significant harm, some may develop heart failure symptoms if the rhythm is too rapid and uncontrolled. Additionally, atrial fibrillation can slightly increase the risk of stroke due to the potential formation of blood clots within the heart.
Premature Ventricular Contractions (PVCs): Are They Dangerous?
Premature ventricular contractions (PVCs), also known as extra heartbeats or skipped beats, are very common. If you have a structurally normal heart and no underlying heart disease, PVCs are usually considered benign and more of a nuisance than a serious health threat.
If PVCs are frequent and bothersome, lifestyle modifications like reducing caffeine, managing stress, and ensuring adequate sleep are often recommended before considering medication. When medication is necessary to manage symptomatic PVCs, doctors typically start with beta-blockers before moving on to more specialized anti-arrhythmic drugs. In many cases, these simple measures are enough to significantly improve symptoms.
PVCs Are Common and Usually Benign
To reiterate, PVCs are a common heart rhythm variation. In the vast majority of cases, they are not a sign of underlying heart problems and often resolve on their own without needing specific treatment beyond reassurance from a healthcare professional.
Exercise and Palpitations: What’s the Connection?
The relationship between exercise and palpitations, particularly PVCs, is complex. Many people experience palpitations or PVCs both before and after exercise, but surprisingly, not during the exercise itself.
As you begin exercising, your heart rate naturally increases. This increased heart rate often causes PVCs or other extra beats to disappear. However, after exercise, your body’s adrenaline level remains elevated for a while as your heart rate gradually returns to resting levels. This period after exercise can create an environment where extra beats reappear, sometimes even more frequently than before exercise.
If palpitations related to exercise are mild and not accompanied by other symptoms, there is usually no cause for serious concern. However, if you experience palpitations along with symptoms like shortness of breath, chest discomfort, significant dizziness, or fainting during or after exercise, it’s important to seek medical evaluation.
How Accurate is an Electrocardiogram (EKG) for Palpitations?
An electrocardiogram (EKG or ECG) is a valuable tool for assessing the electrical activity of your heart. It provides a snapshot of your heart’s rhythm over approximately 12 seconds. If you happen to be experiencing palpitations during those 12 seconds, the EKG may capture the abnormality. However, palpitations are often intermittent, meaning they don’t occur constantly. This is why doctors frequently use ambulatory EKGs, like Holter monitors, which record your heart rhythm over a longer period, to increase the chance of capturing palpitations and making a diagnosis.
Even if an EKG doesn’t capture palpitations directly, it can still be helpful. It can reveal signs of other underlying heart issues, such as evidence of a previous heart attack or other electrical abnormalities, which might provide important clues about the cause of your palpitations. Therefore, while an EKG is a crucial part of a heart evaluation, it’s not always the most sensitive test for detecting heart rhythm abnormalities, especially if they are infrequent.
Holter Monitors and Other Advanced Monitoring
Besides Holter monitors, other types of extended heart rhythm monitoring are available. Event monitors are devices that you wear and activate to record your heart rhythm when you feel palpitations. These can be worn for up to a month, allowing for better correlation between your symptoms and your heart rhythm at the time of the palpitations.
In rare cases, for infrequent palpitations or situations where wearing a traditional monitor is impractical (like during competitive sports), an implantable loop recorder might be used. This small device is placed under the skin and can record your heart rhythm for up to three years, capturing even infrequent arrhythmias.
Can Pregnancy Trigger Heart Palpitations?
Yes, pregnancy can indeed cause heart palpitations. Many women experience their first episode of rapid heart action and palpitations during pregnancy. This is understandable because pregnancy causes significant changes in blood volume and places additional stress on the heart. These physiological changes can sometimes bring out a tendency for rapid heart rhythms that weren’t apparent before pregnancy.
After pregnancy, palpitations may resolve, or they might start occurring under other stressful situations. It’s important to know that palpitations during pregnancy don’t necessarily indicate an underlying heart problem.
Conversely, women with a history of heart rhythm problems or fainting spells prior to pregnancy may actually experience a decrease in their symptoms during pregnancy. This is because pregnancy increases cardiac output and blood volume, which can sometimes stabilize heart rhythms.
What Medications Are Used to Prevent Palpitations?
There are numerous medications available to treat more serious heart rhythm disorders. These medications are typically prescribed by a cardiologist (heart specialist) because they can have significant side effects. If not used correctly, they can potentially cause serious cardiovascular problems, including cardiac arrest or sudden death.
However, when used appropriately and under medical supervision, these medications can effectively prevent serious heart rhythm disorders and improve quality of life. Despite their effectiveness, many patients prefer to avoid these medications due to potential side effects, cost, and the need for frequent doses.
Can a Pacemaker Help with Palpitations?
Pacemakers are sophisticated devices primarily used to treat slow heart rhythms. However, in recent years, advanced pacemakers and implantable cardioverter-defibrillators (ICDs) have become available for patients with severe heart rhythm disorders that cause rapid heart rates or life-threatening arrhythmias. ICDs can deliver an electrical shock to restore a normal heart rhythm automatically when a dangerous arrhythmia occurs. These devices are highly specialized and are prescribed and managed by cardiologists specializing in heart rhythm management (electrophysiologists).
Do Herbal Remedies Help with Palpitations?
Currently, there are no scientifically proven herbal remedies specifically effective for treating heart palpitations. However, it’s worth noting that low levels of potassium or magnesium in the body have been linked to palpitations and, in some cases, more serious heart rhythm disorders. In such cases, ensuring adequate intake of potassium and magnesium through diet or supplements can be beneficial. Always consult with your doctor before starting any herbal supplements, especially if you have heart conditions or are taking medications.
Panic Attacks and Heart Pounding: Is There a Link?
Yes, panic attacks and anxiety are strongly linked to heart palpitations. The “startle effect” and feelings of anxiety trigger the release of adrenaline and other stress hormones in the body. These hormones cause your heart rate to increase and your heart to beat more forcefully, leading to the sensation of heart pounding, racing heart, and palpitations. This experience is essentially becoming aware of the normal functioning of your nervous system’s response to stress or perceived threat. Anxiety, panic, and even sudden surprises can elevate adrenaline levels and cause the sensation of palpitations.
Why Do Palpitations Happen When Bending Forward?
Experiencing palpitations when bending forward is often related to increased pressure in the abdomen. When you bend over, intra-abdominal pressure increases and can be transmitted upwards to the esophagus, particularly if you have a hiatal hernia. The esophagus lies close to the left atrium of the heart. This pressure can sometimes trigger palpitations, and it’s a common cause of non-cardiac palpitations (palpitations not originating from the heart itself).
Esophageal Motility Disorders and Palpitations
People with esophageal motility disorders, conditions affecting the movement of the esophagus, may also experience palpitations. In these cases, the sensation of palpitations may be related to esophageal spasms or dysfunctions, and there might not be any underlying cardiac rhythm abnormality. The brain can sometimes misinterpret sensations from the stomach, esophagus, or even chest wall muscles as originating from the heart, leading to the perception of palpitations. These types of palpitations are usually benign and don’t require specific treatment in most cases.
Are Palpitations I Can Feel More Serious Than Those I Don’t?
No, there’s generally no difference in prognostic significance between PVCs or palpitations that you can feel and those you don’t perceive. Symptomatic palpitations, the ones you are aware of and feel, are understandably more concerning to the individual because they can be bothersome and distracting. However, from a medical standpoint, all PVCs are considered the same in terms of their potential health implications. For most people who are otherwise healthy, the presence of PVCs on a Holter monitor, regardless of whether they are felt or not, is usually of little prognostic concern.
What If My Child Complains of “Skipped Beats”?
The same general principles apply to children experiencing “skipped beats” or palpitations as to adults. In the vast majority of children, the causes of skipped beats are benign and don’t require treatment. However, it’s important not to ignore these complaints in children. It’s essential to rule out any underlying electrical or structural abnormalities of the heart.
If a child occasionally notices a “skipped beat” but is otherwise healthy, active, and keeps up with peers during physical activity, it’s unlikely that anything serious is going on.
When to Seek Medical Attention for a Child’s Palpitations
While most palpitations in children are benign, certain symptoms warrant medical attention. Seek medical advice for a child experiencing palpitations, especially if they are accompanied by:
- Chest pain
- Shortness of breath
- Lightheadedness
- Fainting spells
In such cases, it’s important to consult with their pediatrician. The pediatrician may then refer the child to a pediatric cardiologist for further evaluation if necessary.
What is Sudden Death in Relation to Heart Palpitations?
Sudden death, in a cardiac context, refers to a situation where a person abruptly loses heart function. Without immediate intervention, death will occur within minutes. Effective assistance involves cardiopulmonary resuscitation (CPR) and often electrical cardioversion to restore a normal heart rhythm. Individuals who are successfully resuscitated after sudden cardiac arrest require extensive evaluation to determine the underlying cause and prevent future occurrences.
Implantable defibrillator devices have become a cornerstone in the care of patients at high risk of sudden cardiac death. These devices have proven highly effective in preventing death from heart arrhythmias in individuals who have experienced a prior episode of attempted sudden death or are at high risk.
Want to know more about your heart health? Take a moment to learn more with the Men’s Health Assessment. (While titled “Men’s Health Assessment,” the information is broadly relevant to heart health for all adults.)
