Heart palpitations are an uncomfortable awareness of one's own heartbeat. Many people experience heart palpitations every now and then due to stress and other factors. While palpitations are usually no cause for alarm, they can sometimes be indicative of greater cardiac issues, so patients should see their doctors to identify the source of their palpitations and find ways to reduce them.
Definition & Facts
Palpitations may be felt in a patient's chest, neck or throat. They can occur when the heart rhythm is normal or abnormal. When a patient feels a palpitation, they are simply noticing their heart's normal, constant function of pumping blood. Most healthy human hearts beat between 60 and 100 times each minute, but some athletes and patients who take cardiac medications may have lower resting heart rates.
A heart rate greater than 100 beats per minute is a condition called tachycardia, and a heart rate lower than 60 beats per minute is termed bradycardia. An occasional extra heartbeat is called an extrasystole. Heart palpitations are usually not serious; however, an abnormal heartbeat, also called an cardiac arrhythmia, could indicate a major health problem.
Symptoms & Complaints
- an acute awareness of one's own heartbeat
- the feeling that the heart is racing, pounding, fluttering or skipping beats
Patients experiencing heart palpitations for the first time should not be alarmed, but they should talk about it with their doctor during their next check-up. Patients should immediately call emergency services if palpitations are accompanied by any of the following symptoms:
Patients experiencing heart palpitations should contact their doctor as soon as possible if:
- they regularly feel extra heartbeats
- they have high blood pressure, high cholesterol, diabetes or other risk factors for cardiovascular disease
- their palpitations suddenly change in frequency or duration
- their pulse is greater than 100 beats per minute in the absence of anxiety or exercise
Palpitations can stem directly from underlying cardiac problems, or they may be indirectly related to the heart. For example, some indirect causes of heart palpitations include:
- Panic attacks or episodes of extreme stress or anxiety
- Excessive exercise
- Alcohol consumption
- Stimulants such as caffeine, nicotine and illicit drugs like amphetamines
- other medical issues such as low blood sugar, low blood pressure, anemia, dehydration or thyroid disease
- Hormonal shifts related to menstruation, pregnancy or menopause. Women who have heart palpitations while pregnant should be tested for anemia.
- Some medications and nutritional supplements
- Electrolyte abnormalities
- Eating large quantities of certain food products including carbohydrates, nitrates, sodium, sugar, fat or monosodium glutamate.
Palpitations after eating could be indicative of sensitivity to a certain food. Recording meals in a diary can help patients pinpoint problem foods.
Palpitations that are a result of underlying cardiovascular problems usually manifest as arrhythmia, or an abnormal heart rate. Some heart issues that can cause palpitations include:
- Coronary artery disease
- Congestive heart failure
- Heart valve abnormalities
- high risk factors for cardiovascular disease
- past history of heart attack
Diagnosis & Tests
To identify the source of a patient's heart palpitations and to make sure they aren't a sign of greater problems, doctor can start by performing a physical exam and asking patients about their diet and lifestyle habits. Doctors should ask about the frequency of palpitations and at what times they are most likely to occur.
- a electrocardiogram, or ECG, interprets the heart's electrical signals to identify rhythm abnormalities. An ECG may be conducted while the patient is exercising or at rest.
- a Holter monitor is a device that patients wear on their chest, which tracks the heart's electrical signals over the course of a day or two. Holter monitors may pick up abnormalities that an ECG missed.
- an event recorder is another device that patients carry around with them, but it is manually operated and designed to only record electrical signals when symptoms arise.
- an echocardiogram, which uses ultrasound technology to examine the structure and function of the heart
In some circumstances, doctors may need to refer patients to a cardiologist for more exams or treatment.
Treatment & Therapy
Heart palpitations are usually not dangerous, and they often stop without treatment. If no underlying medical problems are found during testing, patients should try to identify and avoid things that stimulate palpitations. Some medications can trigger palpitations; doctors can prescribe alternative medications if this is the case.
Some effective tactics for managing heart palpitations include:
- Stress reduction techniques such as yoga, breathing exercises, meditation, aromatherapy, biofeedback or tai chi
- avoiding nicotine, alcohol, caffeine, illicit drugs and other substances that increase heart rate
- discontinuing nutritional supplements and medications that can act as stimulants like some cold medicines
Palpitations that are the result of a medical problem necessitate treatment of the underlying condition. If an arrhythmia is detected, the patient may require medication or surgery. A referral to an electrophysiologist, or heart rhythm specialist, may also be necessary.
Prevention & Prophylaxis
Quitting smoking can help reduce palpitations and potentially extend a patient's life for several years. Even very healthy people can still experience heart palpitations under stress or due to the influence of stimulants such as caffeine, but symptoms quickly abate. Patients who regularly have palpitations should avoid triggers and learn ways to cope with stress.
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