Heart palpitations: Causes, tests, and treatment

In general, people are unaware of their heartbeat. A heart palpitation is when someone has a heightened awareness of their heartbeat because it does not feel right. This may be because their heart is pounding too hard, too fast, too slow, or irregularly.

This article explores the causes of heart palpitations, how to test for them, and how they are treated.

Overview

Heart palpitations may be felt in the neck, throat, or chest, and may vary greatly from person to person.

Heart palpitations can vary greatly in terms of what a person feels. Common descriptions include:

• fluttering
• skipped or extra beat (also known as ectopic beats)
• feeling like you have just exercised
• beating harder
• beating faster

Palpitations can also be felt in the neck, throat, or chest, or even sometimes in the ear if the person is lying down.

For some people, palpitations last only for a few seconds, while in other cases, they can go on for minutes at a time.

For most people, heart palpitations are not a regular occurrence. While they may be worrying, most cases are harmless and do not signal a serious problem.

However, some people experience many palpitations a day and often describe them as making them feel like they are having a heart attack.

Common causes

Many things can trigger heart palpitations. Some of the more common causes can be broken down into different categories.

Emotional

Emotional factors can also cause heart palpitations. These include:

Medication

Certain medications can cause heart palpitations. These include:

• asthma inhalers
• antihistamines
• thyroid hormone replacement medications
• antiarrhythmic medications
• antibiotics
• antidepressants
• antifungal therapy
• some cough and cold medicines
• some herbal or nutritional supplements

Medical conditions

Underlying medical conditions may be the cause of heart palpitations. These include:

• overactive thyroid
• anemia
• low blood sugar
• low potassium
• dehydration
• high temperature and fever
• loss of blood
• shock
• low oxygen or carbon dioxide levels in the blood

Hormone changes

Hormonal changes are another possible cause of heart palpitations. Changes in hormone levels may result from:

Heart conditions

Palpitations can also be caused by heart conditions, including:

Lifestyle

Common heart palpitation triggers include caffeine and alcohol.

Lifestyle factors that may cause heart palpitations include:

• caffeine (found in tea, coffee, and energy drinks)
• alcohol
• smoking tobacco
• strenuous exercise
• illegal drugs (such as cannabis, cocaine, heroin, ecstasy, and amphetamines)
• rich or spicy food

Complications

While most cases of heart palpitations are harmless, if they are the sign of an underlying heart condition, then there can be serious complications.

Complications include:

• Fainting due to a fast heartbeat, where blood pressure simultaneously drops to a very low level.
• Stroke can damage the brain, or even lead to death.
• Supraventricular tachycardia (SVT) can occur at any age. During transient episodes, the rapid heart rate typically starts and ends abruptly.
• Atrial fibrillation can lead to an ischemic stroke; can be isolated or related to another underlying heart disease.
• Ventricular tachycardia (VT) where the heart rate reaches100 beats per a minute and is out of time with the atria (upper heart chambers). May indicate a pre-existing underlying heart disease.
• Ventricular fibrillation (VF) occurs if VT is untreated; most common in people with pre-existing heart disease. The person could die suddenly if not given emergency treatment.

Other complications include cardiac arrest and heart failure.

Tests and diagnosis

Palpitations that are harmless will often pass quickly and occur rarely. People rarely need to see a doctor when they happen, as treatment probably won't be necessary.

However, in some situations, speaking to a doctor about heart palpitations is a good idea. These include:

• if the person has a history of heart problems
• if the palpitations do not improve or get worse
• if the associated symptoms are severe
• if the person has any other health concerns

Of course, palpitations often come and go and will often not occur at the doctor's office. It is therefore important to record:

• what they feel like
• how often they happen
• when they happen

Being able to answer some of the following questions may help the doctor:

• During a palpitation episode, is the heart rate too fast or slow, and is the rhythm regular or irregular?
• Is there light-headedness, dizziness, shortness of breath, or chest pain?
• Do they occur when a person is doing the same thing?
• Do the palpitations start and stop suddenly, or fade in and out?

Often the first thing the doctor will do is a physical exam. They can detect many of the causes of heart palpitations this way.

They will also ask about the person's symptoms and look at their medical history.

Another standard test for assessing palpitations is a 12-lead electrocardiogram (ECG), which measures heart rate and rhythm parameters through electrical tracing.

The doctor may also conduct blood tests, echocardiography, an exercise stress test, or an electrophysiology study, depending on the symptoms.

Treatment and prevention

Preventive lifestyle changes that may reduce heart palpitations include getting enough sleep and reducing stress.

Treatment for heart palpitations will depend on the symptoms and what is causing the problem.

In general, treatment falls into three categories:

Preventive

Often, simple lifestyle changes that avoid triggers can help reduce or stop non-serious palpitations. These changes include:

• cutting back on caffeine
• stopping tobacco use
• cutting back on alcohol
• eating healthful foods regularly
• getting enough sleep and exercise
• cutting out over-the-counter medications that can cause heart palpitations
• reducing stress and anxiety (yoga, meditation, breathing exercises, and tai chi have all been found to help)

Medication

The doctor may decide that the person needs to take antiarrhythmic prescription drugs, such as beta-blocker or non-dihydropyridine calcium channel blocker therapy.

Beta-blockers slow the heart rate, in addition to reducing blood pressure.

If these do not work as they should, then occasionally a different antiarrhythmic drug may be given, such as one that directly targets the sodium or potassium channels of the heart.

Medical procedure

Three main types of medical procedure are used in cases of severe heart palpitations. They are:

• Catheter ablation: An ablation device is threaded into the heart through a catheter by accessing a deep vein in the groin, neck, or chest. The ablation device causes scar formation over the abnormal electrical tracts in the heart to correct how the electrical impulses travel through the heart.
• Electrical synchronized cardioversion: One or more electrical shocks are sent into the chest wall to try to achieve a normal rhythm and rate.
• Implantable pacemaker or defibrillator placement: This is a special type of permanent cardiac device that monitors and treats electrical disease in the heart.

Written by Tom Seymour

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