Heart palpitations (pal-pih-TAY-shuns) are the feelings of having rapid, fluttering or pounding heart. Heart palpitations can be triggered by stress, exercise, medication or, rarely, a medical condition.

Although heart palpitations can be worrisome, they're usually harmless. In rare cases, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that may require treatment.

Heart palpitations can feel like your heart is:

  • Skipping beats
  • Fluttering
  • Beating too fast
  • Pumping harder than usual

You may feel heart palpitations in your throat or neck, as well as your chest. Heart palpitations can occur whether you're active or at rest, and whether you're standing, seated or lying down.

When to see a doctor

Palpitations that are infrequent and last only a few seconds usually don't require evaluation. If you have a history of heart disease and have frequent palpitations or have palpitations that worsen, talk to your doctor. He or she may suggest heart-monitoring tests to see if your palpitations are caused by a more serious heart problem.

Seek emergency medical attention if heart palpitations are accompanied by:

  • Chest discomfort or pain
  • Fainting
  • Severe shortness of breath
  • Severe dizziness

Often the cause of your heart palpitations can't be found. Common causes of heart palpitations include:

  • Strong emotional responses, such as stress or anxiety
  • Strenuous exercise
  • Caffeine
  • Nicotine
  • Fever
  • Hormone changes associated with menstruation, pregnancy or menopause
  • Taking cold and cough medications that contain pseudoephedrine, a stimulant
  • Taking some asthma inhaler medications that contain stimulants

Occasionally heart palpitations can be a sign of a serious problem, such as an overactive thyroid gland (hyperthyroidism) or an abnormal heart rhythm (arrhythmia). Arrhythmias may include very fast heart rates (tachycardia), unusually slow heart rates (bradycardia) or an irregular heart rhythm.

You may be at risk of developing palpitations if you:

  • Are highly stressed
  • Have an anxiety disorder or regularly experience panic attacks
  • Are pregnant
  • Take medicines that contain stimulants, such as some cold or asthma medications
  • Have an overactive thyroid gland (hyperthyroidism)
  • Have other heart problems, such as an arrhythmia, heart defect or previous heart attack

Unless a heart condition is causing your heart palpitations, there's little risk of complications. For palpitations caused by a heart condition, possible complications include:

  • Fainting. If your heart beats rapidly, your blood pressure may drop, causing you to faint. This may be more likely if you have a heart problem, such as congenital heart disease or certain valve problems.
  • Cardiac arrest. Rarely, palpitations can be caused by life-threatening arrhythmias and can cause your heart to stop beating effectively.
  • Stroke. If palpitations are due to atrial fibrillation, a condition in which the upper chambers of the heart quiver instead of beating properly, blood can pool and cause clots to form. If a clot breaks loose, it can block a brain artery, causing a stroke.
  • Heart failure. This can result if your heart is pumping ineffectively for a prolonged period due to an arrhythmia, such as atrial fibrillation. Sometimes, controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.

If you have heart palpitations with severe shortness of breath, chest pain or fainting, you should seek emergency medical attention. If your palpitations are brief and there are no other worrisome signs or symptoms, make an appointment to see your doctor. Your doctor can help you find out if your palpitations are harmless or a symptom of a more serious heart condition.

If you make an appointment with your doctor, it's good to prepare. Here's some information to help you get ready for your appointment:

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet or fast.
  • Write down any symptoms you're experiencing, including any that seem unrelated to heart palpitations.
  • Write down key personal information, including family history of heart disease, arrhythmias, stroke, high blood pressure or diabetes. Also include major stresses or recent changes in your life.
  • Make a list of medications, vitamins and supplements you're taking.
  • Take a family member or friend along, if possible. Someone who accompanies you may remember something you miss or forget.
  • Be prepared to discuss your diet and exercise habits, including challenges you might face in improving your diet or moving more.
  • Write down questions to ask your doctor.

To make the most of your time with your doctor, write down questions to ask. For heart palpitations, some basic questions include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes?
  • What should I do if my symptoms return?
  • What tests will I need?
  • Do I need treatment and, if so, what?
  • What are the alternatives to the primary approach you're suggesting?
  • What's an appropriate level of physical activity?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Do you have brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did you begin having heart palpitations?
  • Have your symptoms been continuous or occasional?
  • Do your palpitations start and stop suddenly?
  • Does it seem like your palpitations have a pattern, such as occurring the same time every day or when you do a certain activity?
  • Does your heart still beat regularly during the palpitations?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Are you having other symptoms such as shortness of breath, chest pain, fainting, or dizziness when you have palpitations?
  • Have you ever had heart rhythm problems before, such as atrial fibrillation?

What you can do in the meantime

Before your appointment, you can try to improve your symptoms by avoiding activities or stresses that might cause your palpitations. Some common triggers include anxiety or panic attacks, drinking too much caffeine or alcohol, or taking some medications or supplements that contain stimulants, such as energy drinks or some cold medicines.

If your doctor thinks you have heart palpitations, he or she will listen to your heart using a stethoscope. Your doctor may also look for signs of medical conditions that can cause heart palpitations, such as a swollen thyroid gland.

Other tests your doctor may perform include:

  • Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat.

  • An ECG can help your doctor detect irregularities in your heart's rhythm and structure that could cause palpitations. The test may be performed while you rest or exercise (stress electrocardiogram).

  • Holter monitoring. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect heart palpitations that aren't found during a regular ECG exam.
  • Event recording. If you don't have irregular heart rhythms while you wear a Holter monitor, your doctor may recommend an event recorder.

    You wear an event recorder as much as possible throughout the day, and push a button on a recording device you wear on your belt to record your heartbeat when you have symptoms. You may need to wear an event monitor for several weeks.

  • Echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function.

    Ultrasound waves are transmitted, and their echoes are recorded with a device called a transducer that's held outside your body. A computer uses the information from the transducer to create moving images on a video monitor.

Unless your doctor finds that you have a heart condition, heart palpitations seldom require treatment. Instead, your doctor may recommend ways for you to avoid the triggers that cause your palpitations.

If your palpitations are caused by a condition, such as an arrhythmia, your treatment will focus on correcting the condition.

The most appropriate way to treat palpitations at home is to avoid the triggers that may cause your symptoms. Some ways to avoid triggers include:

  • Reduce stress or anxiety. Try relaxation techniques, such as meditation, yoga, or deep breathing or aromatherapy.
  • Avoid stimulants. Stimulants, including caffeine, nicotine, some cold medicines and energy drinks, can make your heart beat quickly or irregularly.
  • Avoid illegal drugs. Certain drugs, such as cocaine and amphetamines, can bring on heart palpitations.
Apr. 02, 2014