Heart Palpitations: What They Are, Causes, Symptoms, and Treatment

Heart palpitations are among the top reasons for visits to emergency rooms and cardiology clinics. The term "heart palpitations" refers to the sensation of an accelerated heartbeat, an irregular heartbeat, or a change in rhythm. Due to these changes in how the heart functions, a person may feel as if something is pounding strongly in their neck or chest. While the underlying causes of heart palpitations are generally benign, it’s important to note that, in some cases, they can be due to life-threatening conditions, so caution is necessary.

What Are Heart Palpitations?

Heart palpitations are the sensation of having a fast-beating or pounding heart. They may be triggered by stress, exercise, medications, or, less commonly, an underlying medical condition. Although heart palpitations can be worrisome, they are typically harmless.

Causes of Heart Palpitations

Heart palpitations can have multiple causes. Studies have shown that in about 4 out of every 10 people with palpitations, the cause is heart-related, while in about 3 out of every 10 people, the palpitations are related to psychiatric factors.

Heart palpitations due to cardiac causes can result from structural heart issues or conditions that increase the heart's workload, such as anemia or pregnancy. Vascular problems can also contribute to the sensation of palpitations.

Palpitations that occur during physical activity or periods of high stress are usually due to stimulating hormones released by the body in response to these conditions.

Psychiatric disorders such as depression, anxiety disorders, or panic attacks can also lead to palpitations. However, caution is advised, as palpitations in these individuals may also be related to heart issues.

An overactive thyroid, known as hyperthyroidism, often causes palpitations. Additionally, low blood sugar, fluctuations in calcium, magnesium, or potassium levels in the bloodstream can result in palpitations.

Common factors associated with heart palpitations include:

• Strong emotional responses such as stress, excessive anxiety, or panic attacks
• Depression
• Intense physical exercise
• Consumption of caffeine, nicotine, or other stimulants
• Fever
• Hormonal changes during menstrual periods, pregnancy, or menopause
• Abnormal thyroid hormone levels
• Use of certain herbal supplements

Heart-related causes of palpitations may include life-threatening conditions such as irregular heart rhythms (arrhythmias), a history of heart attack, coronary artery issues, heart valve disorders, cardiomyopathies, and heart failure.

Risk Factors for Heart Palpitations

Risk factors for heart palpitations are generally related to their underlying causes. Increased stress levels, psychiatric conditions like anxiety disorders and panic attacks, pregnancy, the use of stimulant-containing medications, thyroid disorders, and existing heart conditions all increase the risk of experiencing palpitations.

What Are the Symptoms of Heart Palpitations?

The symptoms of heart palpitations, especially when they occur suddenly or are experienced for the first time, can cause intense anxiety. There are several symptoms that can be defined as heart palpitations:

• Feeling as though the heart stops briefly and then starts beating again
• A fluttering sensation in the chest, often described as a bird flapping
• A sudden sensation that the heartbeat is either speeding up or slowing down

These sensations can occur not only in the chest area but also in the neck and throat. If short-lived palpitations become more frequent over time or their intensity changes, it is recommended to consult healthcare providers for guidance on managing this symptom.

If heart palpitations are accompanied by chest pain or discomfort, shortness of breath, fainting, or dizziness, they may indicate serious medical conditions that require urgent attention.

How Is Heart Palpitation Diagnosed?

For individuals seeking medical help for palpitations, physical examination and medical history are crucial in the diagnostic process. Factors that may influence the onset or pattern of the symptom are assessed, including accompanying symptoms, medications, or supplements that may contribute to the sensation of palpitations.

After an initial evaluation, doctors may order tests to investigate the underlying issue. Common diagnostic approaches include biochemical blood tests, ECG (electrocardiogram), Holter monitoring, event recorders, or echocardiography (ECHO) to visualize the heart using sound waves.

Laboratory Tests

Common lab tests for individuals with heart palpitations include a complete blood count, blood urea, creatinine, and electrolyte levels. Thyroid hormone levels may also be checked if the doctor suspects a condition like hyperthyroidism.

ECG (Electrocardiography)

An ECG captures the heart’s electrical activity through electrodes placed on the chest, printing the data on paper. It can detect rhythm disorders or structural abnormalities related to palpitations.

Holter Monitor

A Holter monitor is a portable device that records continuous ECG data over 1-3 days. If a standard ECG does not provide sufficient information, a Holter monitor may help detect changes in heart activity outside the hospital setting.

Event Recorders

Event recorders can capture ECG over extended periods, such as weeks or months, and are useful for those who experience palpitations infrequently. The recording is initiated when the patient activates the device during a palpitation episode, allowing for a few minutes of ECG capture.

How Are Heart Palpitations Treated?

The treatment of heart palpitations depends on addressing the underlying cause. If rhythm disorders are identified as the cause, procedures like radiofrequency ablation may be beneficial. For those with functional heart issues, medications like beta blockers or calcium channel blockers may be prescribed.

A key principle in treating palpitations is to avoid triggering factors. Important lifestyle changes that may help reduce palpitations include managing stress through relaxation techniques like yoga or breathing exercises and avoiding stimulants. Other beneficial lifestyle adjustments, under a doctor’s guidance, include quitting smoking, engaging in regular physical activity, and maintaining a healthy, balanced diet.