Heart Palpitations: Overview and More

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Symptoms
Causes
Diagnosis
Treatment

Heart palpitations are noticeable changes in the way the heart beats. They are not a disease or condition, but rather a symptom. Most people with palpitations have some type of cardiac arrhythmia—an irregular heartbeat.

Most arrhythmias are benign, meaning they are not life-threatening. However, some can be a symptom of a serious heart problem. Heart palpitations also are a side effect of certain medications and other substances, such as caffeine and nicotine.

Palpitations are the second most common reason people see a cardiologist (heart specialist).

This article describes the different ways you might experience heart palpitations, why you may be having them, and how a doctor will diagnose and, if necessary, treat the underlying cause.

Man being treated by a first responder — Janie Airey / Photodisc / Getty Images

Heart Palpitation Symptoms

Although heart palpitations are a symptom or a side effect rather than a distinct disease or condition, people experience them in different ways. Among the most common are:

The sensation of the heart skipping a beat
A heartbeat that sometimes feels too strong
Rapid irregular heartbeats
Irregular heartbeats

These sensations are all felt in the chest. Some people with a specific type of heart arrhythmia notice palpations in their neck.

Causes

Heart arrhythmias are the most common cause of palpitations. However, there are a number of heath conditions as well as medications and other substances that can make the heart beat abnormally.

Arrhythmias

Most any type of heart arrhythmia can cause palpitations. The most common are not dangerous. They include premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).

However, some palpitations are caused by dangerous arrhythmias, such as ventricular tachycardia.

When palpitations have a cardiac cause, they're most likely to occur in people who have heart disease or or who experience palpitations at work or during sleep. Palpitations in the neck usually are a symptoms of a type of heart arrhythmia called AV node reentrant tachycardia (AVnRT).

Medical Conditions

Health problems that may cause heart palpitations include:

Anxiety
Overactive thyroid
Low blood sugar
Low carbon dioxide
Low potassium
Anemia
Dehydration
Blood loss
Shock
Pregnancy

Medications and Other Substances

Certain over-the-counter (OTC) and prescription drugs are associated with heart palpitations, as are some legal and illegal substances, among them:

Cough and cold medications
Decongestants
Diet pills
Beta blockers
Some herbal supplements
Asthma inhalers
Thyroid medications
Caffeine
Nicotine
Alcohol
Illegal drugs such as cocaine and amphetamines

Recap

Heart palpitations are changes in the way the heart beats that you can feel in your chest. They often are caused by heart arrhythmias that may be worrisome but are not life-threatening, although some arrhythmias can be dangerous and require treatment. There are many other things that can cause heart palpitations, including certain health conditions, medications, and legal and illegal substances.

Diagnosis

If you have heart palpitations, your cardiologist will do an electrocardiogram (ECG), a test that measures the electrical activity of the heart. It produces what's known as a tracing of the heart's rhythm that looks like squiggly lines on a long sheet of special paper.

An ACG can tell your doctor if a heart rhythm disturbance is causing your palpitations and help them identify the particular type of arrhythmia it is.

In order to diagnose a heart arrhythmia correctly, the doctor will need to do the ECG while you're having the palpitations. That is, the palpitations have to be captured in real time during the test.

This can be tricky if your palpitations happen sporadically. In this case, your cardiologist may do what's called ambulatory electrocardiographic monitoring (AECG).Ambulatory monitoring systems involve attaching the monitor to your body as you go about your day.

There are several types of ambulatory monitoring. They include Holter monitoring, which records heart rhythms over 24 to 48 hours or for up to several weeks; an event recorder; and an implantable loop recorder, which involves minor surgery to place a device in the chest to minitor heart rhythms for up to three years.

Treatment

Heart arrhythmias that cause palpitations often do not need to be treated. An important exception is ventrcular tachycardia, which if not treated can lead to cardiac arrest and even death.

When a heart arrhythmia dose require treatment, the options include:

Medications: Antiarrhythmic medications that directly affect the heart to help it beat normally, including Betapace (sotolol), Tambocor (flecainide), Rhythmol (propafenone), and Cordarone, Pacerone (amiodarone). Calcium channel blockers, beta blockers, and anticoagulants—drugs that thin the blood and prevent it from clotting—also sometimes are prescribed to treat heart arrhthmias.
Radiofrequency ablation: A procedure in which a type of energy similar to the energy given off by a microwave is used to destroy the areas of the heart causing an irregular heartbeat
An implantable cardioverter defibrillator (ICD): A device implanted under the skin that is connected to the heart with wires. The ICD tracks the heart rate; if it becomes irregular it will use an electric shock to make the heart beat normally.

If something other than an arrhythmia is causing heart palpitations, the treatment will depend on what it is. This can mean anti-anxiety medication and therapy for someone who has palpitations due to extreme anxiety, for example, or treatment for a condition such as hyperthyroidism or low blood sugar.

When a prescribed medication is to blame for heart palpitations, changing the dose or switching to another drug may stop them from happening. Cutting back on caffeine or alcohol, quitting smoking, and steering clear of OTC or illicit drugs, when any of these cause palpitations, also should prevent them.

Summary

Heart palpitations are noticeable changes in the way the heart beats. They can be caused by an irregular heart best called an arrhythmia, as well as health conditions that do not involve the heart such as an overactive thyroid or anxiety, certain medications, and caffeine, nicotine, and illegal drugs.

To diagnose palpitations related to a heart problem, a cardiologist will do an ECG or other form of monitoring. Treatment for heart palpitations will depend on the cause and can range from medications or procedures for an arrhythmia or other health condition to making changes in medications to cutting back on coffee or quitting smoking.

A Word From Verywell

Feeling your heart seem to skip a beat or beat faster or slower than usual can be unsettling, to say the least. If this happens to you, unless you'e already been diagnosed with a cardiac condition, the likelihood you have a serious heart problem is relatively low. It may be you've simply downed too much coffee or the decongestant you took for a stuffy nose is affecting your heart rate. To be sure, call your doctor. They will be able to figure out what's going on and, if you do have a medical issue, get you the treatment you need.

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