Heart Palpitations Causes and Treatments

Heart palpitations refers to an unusual awareness of the heartbeat. People who experience palpitations most often describe them as "skips" in the heartbeat, periodic heartbeats that feel too strong, or rapid and/or irregular heartbeats.

The symptom of palpitations is common and is the second leading reason to visit a cardiologist. While some people who have palpitations are able to simply ignore them, others find them extremely disturbing or frightening, and may worry that they are about to die at any moment. 

Fortunately, the fact is that the majority of palpitations are not caused by dangerous or life-threatening heart rhythm disturbances. Still, palpitations can occasionally indicate a potentially serious cardiac arrhythmia, so anyone who has palpitations should report them to their doctor. And it is the duty of the doctor to take this symptom seriously.

When you tell your doctor you are having palpitations, he or she will likely take steps to identify the underlying cause of your palpitations, and then give you guidance for treating that cause.

What Kinds of Arrhythmias Produce Palpitations?

Most people with palpitations have some type of cardiac arrhythmia, however most of them are not dangerous. Virtually any arrhythmia can cause palpitations, but the most common causes are premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation and episodes of supraventricular tachycardia (SVT).

However, in some cases palpitations can be caused by more dangerous arrhythmias, such as ventricular tachycardia.

Cardiac causes of palpitations are more likely in people who have heart disease, or people who experience palpitations at work or during sleep. Sensing palpitations in the neck is an indicator a specific arrhythmia, AV node reentrant tachycardia (AVnRT).

Not all people who report palpitations have heart arrhythmias, however. The same sorts of symptoms can be caused by anemia, hormonal diseases (including hyperthyroid), anxiety, medications, or illegal substances.

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How Are Palpitations Evaluated?

If you have palpitations, your doctor's first order of business is to find out whether the palpitations are caused by a heart rhythm disturbance, and to identify the particular arrhythmia that is producing the symptom.

The “trick” in making the diagnosis is to record an electrocardiogram (ECG) at the time the symptoms are occurring. That is, the palpitations have to be “captured” on an ECG. Unfortunately, the process of recording the electrical activity of the heart during active symptoms can be difficult, especially with symptoms that only occur sporadically.

Don't Let These Mistakes Happen to You

Doctors commonly make two mistakes in their attempt to determine the cause of palpitations:

• They often fail to record the arrhythmia that is causing the symptoms.
• They often attribute the palpitations to an arrhythmia that is actually not causing them.

Mistake 1: The doctor will order an ECG (which records the heart rhythm for only 12 seconds) or an ambulatory monitoring study for an insufficient amount of time. When this happens it is often the case that neither the palpitations nor an arrhythmia will be seen during the monitoring period. In such cases doctors have been known to inappropriately conclude that the palpitations are not related to an arrhythmia.

To make a correct diagnosis, the palpitations and ECG recording must occur at the same time. If the palpitations occur only intermittently, and especially if they do not occur every single day, instead of doing an ECG or doing ambulatory monitoring only for a 24-hour or a 48-hour period (the most common lengths of time employed with these studies), much longer periods of recording should be used. Ambulatory monitoring systems are available that can record the heart rhythm for several weeks—or even months—at a time. The point is, to make a definitive diagnosis the recording needs to continue for however long it takes to "capture" an episode. 

Mistake 2: The doctor will see an arrhythmia during the monitoring period that is not associated with palpitations, and blame the palpitations on that arrhythmia. In order to determine that a particular arrhythmia is the cause of the palpitations, the arrhythmia and the palpitations must occur at the same time.

Since doctors all too frequently make these two mistakes, it is important for you to keep in mind this simple rule if you have palpitations: To make a correct diagnosis, an ECG must be recorded at the very time the palpitations are taking place.

Treating Palpitations

Appropriately treating palpitations depends on which arrhythmia is causing them. Different cardiac arrhythmias often require quite different treatment approaches.

Most palpitations are caused by arrhythmias that are completely “benign”—that is, not life-threatening, or dangerous to your health. In these cases, the palpitations are “treated” by explaining to the patient the cause of the sensation and giving reassurance, since anxiety can make palpitations worse. Treating co-existing anxiety or other psychological problems can also help with the effect of palpitations on a person's life. Increased exercise to improve cardiovascular fitness (if a doctor says its safe) and special programs to integrate mind-body sensations can also be helpful.

If the arrhythmia causing the palpitations is potentially dangerous to life or to health, then the arrhythmia itself will need to be addressed. If you turn out to have one of these arrhythmias, you may want to learn more about it, and about the treatment options available.