Heart Palpitations

Overview

Heart palpitations are sensations that may feel like your heartbeat is pounding, racing, or fluttering. 

Palpitations are fairly common, and they generally occur due to extra heartbeats called premature atrial contractions (PACs) or premature ventricular contractions (PVCs). 

Rarely are palpitations due to more worrisome heart problems. 

Symptoms

Symptoms of heart palpitations may include a passing sensation of a pounding, rapid, fluttering, or skipped heartbeat. These sensations are usually felt in the chest but may also be felt in the neck or the throat. 
Generally, there are two broad types of palpitations.

Not Worrisome:

• These are very common.
• They are felt as a skipped heartbeat, followed by a strong thump or heartbeat. Most people report that they feel as if the heart stopped for a second, then started right up again. There may be a strong thump once or twice. Some may feel woozy or lightheaded for a second.
• This is more noticeable at night when you are lying down, at times when you are sitting quietly, and after meals.

These are due to PACs or PVCs. Most people have some PACs throughout the day, but do not notice them. Only when things are quiet do they become more noticeable and bothersome. 

Worrisome:

• These are less common.
• Here, there is a series of several fast heartbeats in a row, one after the other (not just one beat). It may go on for a few minutes or may go on for hours. These fast heartbeats may be regular or irregular.
• This type of palpitation may indicate something more serious.

Other symptoms to watch out for:

• Fainting or feeling faint or dizzy for more than a couple of seconds while you are still having palpitations.
• Breathing difficulty while you are having palpitations.
• Feeling confused or disoriented.
• Back, neck, stomach, or jaw pain or tightness while you are still having palpitations.

These symptoms, occurring together with heart palpitations, may indicate a more serious heart condition or a medical emergency. 

Causes

There are several potential causes of heart palpitations. The more common type of palpitations are caused by PACs or PVCs. Many people have PACs but don’t feel them. These skipped heartbeats can be made more prominent by:

• Dehydration
• High stress and anxiety
• High intake of stimulants, such as caffeine
• Pregnancy
• Smoking or nicotine use
• Overactive thyroid gland
• Medications, such as pseudoephedrine (Sudafed), beta blockers for heart disease, or asthma inhalers
• Other heart conditions

The more uncommon type of palpitations, which are faster and more persistent, may be a heart arrhythmia. A wide range of heart problems can cause these. We will typically evaluate you for these arrhythmias based on your symptoms and our examination of you. 

Digestive disorders may also result in heart palpitations. Gallstones, gastroesophageal reflux disease (GERD), or simple indigestion can cause your symptoms. Asthma may also be an underlying cause. 

Treatments 

Treatment depends on the cause of the palpitations.

If the palpitations are due to PACs or PVCs, the treatment is generally reassurance and an explanation of why they occur. These symptoms are not life-threatening, and no additional testing is necessary in these cases.

Strategies to reduce palpitations can include: 

• Avoiding stimulants like caffeine.
• Using relaxation techniques such as meditation or breathing exercises, if the palpitations are due to stress.
• Avoiding nicotine and marijuana exposure.
• Eating a healthy, nutritious diet.

If your doctor determines that the palpitations are due to a more serious heart condition, they will discuss with you the various options, including medication or surgery.

Your doctor may ask you to track your palpitations by writing down when they occur, how long they last, precisely what they feel like, and any accompanying symptoms.