Heart Palpitations

Normally, you're not aware of your heartbeat. Palpitations occur when you suddenly become conscious of your heart beating, often feeling different than usual. This heightened awareness can result from the heart actually beating abnormally, or from increased sensitivity to normal heartbeats during times of stress or anxiety.

The heart's electrical system controls its rhythm. When this system is disrupted by physical, emotional, or chemical factors, it can cause extra beats, skipped beats, or rapid rhythms that you perceive as palpitations. Most people experience occasional palpitations, and they're usually harmless.

However, palpitations can sometimes indicate heart rhythm disorders (arrhythmias) or other cardiac conditions. The key is distinguishing between benign palpitations and those requiring medical evaluation. Factors like your age, other symptoms, medical history, and the pattern of palpitations help determine their significance.

Lifestyle and Dietary Triggers

• Caffeine: Coffee, tea, energy drinks, chocolate
• Alcohol: Especially binge drinking
• Nicotine: Smoking, vaping, nicotine patches
• Recreational drugs: Cocaine, amphetamines, marijuana
• Dehydration: Electrolyte imbalance
• Heavy meals: Large, rich, or spicy foods
• MSG: In some sensitive individuals

Emotional and Physical Triggers

• Anxiety and stress: Most common cause
• Panic attacks: Severe palpitations
• Intense emotions: Anger, fear, excitement
• Physical exertion: Normal with exercise
• Lack of sleep: Increases sensitivity
• Fever: Raises heart rate

Medical Conditions

• Arrhythmias: Atrial fibrillation, SVT, PVCs
• Hyperthyroidism: Overactive thyroid
• Heart disease: Various types
• Heart valve problems: Mitral valve prolapse
• Anemia: Low red blood cells
• Low blood sugar: Hypoglycemia
• Electrolyte imbalances: Low potassium, magnesium
• Pheochromocytoma: Rare adrenal tumor

Medications and Supplements

• Asthma inhalers: Albuterol
• Decongestants: Pseudoephedrine
• Thyroid medications: If dose too high
• Some antidepressants: Especially starting
• Diet pills: Stimulant-based
• Some antibiotics: Azithromycin
• Herbal supplements: Ephedra, bitter orange

Hormonal Changes

• Pregnancy: Increased blood volume
• Menstruation: Hormonal fluctuations
• Menopause: Estrogen changes
• Thyroid disorders: Hyper or hypothyroidism

Palpitations often occur with other symptoms that help identify the cause:

• Chest pain: May indicate heart problems
• Shortness of breath: Heart or lung issues
• Dizziness: From reduced blood flow
• Sweating: Anxiety or cardiac cause
• Fatigue: Chronic arrhythmias
• Anxiety: Both cause and effect
• Neck pulsations: Visible pulse
• Headache: High blood pressure
• Trembling: Anxiety or thyroid
• Nausea: Vagal response
• Urge to cough: Trying to reset rhythm
• Weakness: Poor cardiac output

• Heart disease history: Previous heart attack, surgery
• High blood pressure: Strains heart
• Thyroid disease: Especially overactive
• Anxiety disorders: Panic disorder common
• Sleep apnea: Stresses heart
• Obesity: Extra cardiac workload
• Diabetes: Affects heart nerves
• Family history: Some arrhythmias genetic
• Stimulant use: Legal or illegal
• Electrolyte disorders: From diuretics, kidney disease
• Age: Risk increases with age
• Stress: Chronic or acute

Medical History

• Description of palpitation sensations
• Frequency and duration
• Triggers and relieving factors
• Associated symptoms
• Medical conditions
• Medications and supplements
• Caffeine and alcohol use
• Stress levels

Physical Examination

• Heart rate and rhythm check
• Blood pressure measurement
• Heart sounds (murmurs)
• Thyroid examination
• Signs of heart failure
• Lung examination

Diagnostic Tests

• ECG/EKG: Records heart rhythm
• Holter monitor: 24-48 hour recording
• Event monitor: Longer-term monitoring
• Echocardiogram: Heart structure ultrasound
• Blood tests: Thyroid, electrolytes, anemia
• Stress test: Exercise ECG
• Electrophysiology study: Detailed rhythm mapping
• Cardiac MRI: Detailed heart imaging

During an Episode

• Sit down and try to relax
• Take slow, deep breaths
• Drink cool water
• Loosen tight clothing
• Try vagal maneuvers
• Check your pulse
• Note the time and duration
• Call 911 if severe symptoms

Tracking Palpitations

• Keep a symptom diary
• Note triggers
• Record time of day
• Duration of episodes
• Associated activities
• What helped stop them
• Share with doctor

Stress Management

• Regular meditation
• Yoga or tai chi
• Progressive relaxation
• Counseling if needed
• Time management
• Hobby engagement
• Social support

• Identify triggers: Keep detailed diary
• Limit stimulants: Coffee, energy drinks
• Stay hydrated: Maintain electrolyte balance
• Regular sleep schedule: 7-9 hours nightly
• Exercise regularly: Strengthens heart
• Manage medical conditions: Control thyroid, blood pressure
• Reduce stress: Practice relaxation daily
• Eat balanced diet: Avoid trigger foods
• Limit alcohol: No more than moderate amounts
• Regular check-ups: Monitor heart health
• Take medications properly: As prescribed
• Avoid illegal drugs: Especially stimulants

Schedule an Appointment For:

• New onset palpitations
• Increasing frequency or duration
• Palpitations with other symptoms
• History of heart disease
• Family history of sudden cardiac death
• Palpitations affecting daily life
• Concern about heart rhythm
• Before starting new exercise program

Red Flags Requiring Urgent Care:

• Very rapid heart rate (>150 bpm at rest)
• Very slow heart rate (<40 bpm with symptoms)
• Irregular pulse that's new
• Palpitations lasting hours
• Associated chest discomfort
• Feeling faint or dizzy