Palpitations

It is important to understand that heart palpitations are a symptom of a condition or a state of the body and not a medical disease in itself. Palpitations are sensations that make a person feel like their heart is pounding or racing. One can feel heart palpitations in the throat or neck too. The symptoms of heart palpitations include the following:

• Being unpleasantly aware of your own heartbeat
• Feeling like your heart has skipped a beat or stopped
• Heart fluttering rapidly
• Pounding heartbeat
• Flip-flopping of heartbeat

Additionally, symptoms that can be associated with palpitations are:

• Shortness of breath
• Chest pain
• Fainting
• Dizziness
• Headache
• Sweating

Palpitations associated with chest pain suggest coronary artery disease, or if the chest pain is relieved by leaning forward, pericardial disease is suspected. Palpitations associated with light-headedness, fainting, or near fainting suggest low blood pressure and may signify a life-threatening abnormal heart rhythm. If a benign cause for these concerning symptoms cannot be found at the initial visit, then ambulatory monitoring or prolonged heart monitoring in the hospital might be warranted.

Noncardiac symptoms should also be elicited since the palpitations may be caused by a normal heart responding to a metabolic or inflammatory condition. Weight loss suggests hyperthyroidism. Palpitations can be precipitated by vomiting or diarrhea that leads to electrolyte disorders and hypovolemia. Hyperventilation, hand tingling, and nervousness are common when anxiety or panic disorder is the cause of the palpitations.

Some common causes of palpitations include the following:

• Experiencing powerful emotional reactions such as stress, anxiety, or panic attacks.
• A difficult workout.
• Undergoing mental health conditions such as depression or anxiety disorder.
• Drinking excessive amounts of food products containing stimulants such as coffee or tea.
• Medications that contain nicotine, amphetamines, cold and cough medications containing pseudoephedrine, asthma inhalers, and withdrawal from beta blockers.
• Experiencing hormonal changes during menstruation or pregnancy.
• Too much or too little thyroid hormones.
• Taking diet pills.
• Fever.
• Low level of oxygen in the blood.
• Blood loss.
• Low blood sugar.

Sometimes, palpitations can be caused by an abnormal heartbeat due to the following medical conditions:

• Abnormal heart valve: Conditions such as mitral valve prolapse affect the flaps or leaflets of the heart that play important roles in the pumping of blood. The mitral valve is present between the left heart chambers and normally bulges into the heart's upper left chamber when the heart contracts. A defect or disease affecting the mitral valve can result in an abnormal heartbeat.
• Heart arrhythmia: Palpitations can be caused by certain conditions that lead to arrhythmia (problems with the heart's rhythm). Common heart arrhythmias include atrial fibrillation, where the heart beats irregularly and faster than normal, atrial flutter, which causes a fast and irregular heartbeat, and supraventricular tachycardia, resulting in an abnormally fast heart rate.
• Abnormal level of potassium: Potassium is a key nutrient influencing heart rate. Low levels of potassium can lead to an irregular heartbeat known as heart arrhythmia. Excessive potassium can also cause irregular heartbeat, leading to a fluttering sensation in the chest, indicating a serious heart condition that requires professional medical advice.
• Heart diseases: Conditions such as congenital heart defects (heart problems that develop during fetal growth), coronary heart disease (caused by plaque buildup in arteries), and cardiomyopathy (causing thick or weak heart muscles) can lead to palpitations.
• Congestive heart failure: Congestive heart failure (CHF) affects the heart's pumping ability and is often referred to as heart failure. This condition results in fluid buildup within the heart, leading to inefficient blood pumping and can cause palpitations and irregular heartbeat.
• Other medical conditions:
  • Sleep apnea: A condition caused by the continuous repetitive collapse of the upper airway during sleep, one of the most common breathing-related disorders.
  • Anemia: A condition due to a decreased number of healthy red blood cells, resulting in insufficient oxygen supply to the body, which can cause palpitations, fatigue, and shortness of breath.
  • Metabolic conditions: Various metabolic conditions can cause palpitations, including hyperthyroidism, hypoglycemia, hypocalcemia, hypermagnesemia, hypomagnesemia, and pheochromocytoma.

Other etiologies include excess caffeine or marijuana, as well as cocaine, amphetamines, and 3-4 methylenedioxymethamphetamine (ecstasy or MDMA), which can also cause palpitations.

• Pregnancy
• Stress
• An overactive thyroid
• Taking medications for cold or asthma
• Anxiety or panic disorder
• Irregular heartbeats
• Previous heart surgery or structural heart changes

To diagnose the cause behind palpitations, your doctor will first conduct a physical exam and listen to your heartbeat using a stethoscope. If your healthcare provider suspects a medical condition behind your palpitations, they will recommend further tests to determine the cause.

Electrocardiogram or EKG

This diagnostic procedure is a quick and painless test that measures the electrical activity of the heart using sticky patches known as electrodes. The electrodes are placed on the patient's chest, arms, and legs, while wires connect the electrodes to a monitor that displays the results. An electrocardiogram helps determine whether a person has a rapid or slow heartbeat.

Holter Monitoring

This is a portable and easy-to-use ECG device that can be worn by the patient for a day or more. The device records the heart rhythm and rate while the patient carries out daily activities. It helps identify heart palpitations that may not be detected during an EKG exam. Smartwatches often contain remote EKG monitoring and can be advised by a doctor.

Event Recording

In cases where an irregular heartbeat is not recorded while wearing a Holter monitor and the event may occur fewer times than once a week, your doctor may recommend event recording. This requires the patient to press a button when they experience symptoms and is usually recommended to be worn for 30 days or more until heart palpitations are experienced.

Implantable Loop Recorder

An implantable loop recorder is a device that is placed subcutaneously and continuously monitors for cardiac arrhythmias. These devices are most often used in individuals with unexplained syncope and can be used for longer periods than continuous loop event recorders. Electrophysiology testing enables a detailed analysis of the underlying mechanism of the cardiac arrhythmia as well as the site of origin.

Echocardiogram

This noninvasive modality uses sound waves to create pictures of the heart in motion. The test helps showcase blood flow and structural problems in the heart, assisting providers in pinpointing the cause of heart symptoms.

Blood Tests

Your healthcare provider may recommend blood tests to check hormone levels, as palpitations can be caused by increased hormone levels seen in cases of pregnancy or menstruation. The blood tests will also help determine the levels of certain electrolytes in the blood that influence heartbeat, such as potassium and calcium.

• Complete blood count can assess anemia and infection.
• Serum urea and creatinine to assess for renal dysfunction.
• Other blood tests, particularly tests of thyroid gland function, are also important baseline investigations (an overactive thyroid gland is a potential cause of palpitations; the treatment, in that case, is to address the thyroid gland overactivity).

Urine Test

A urine test will help determine the levels of electrolytes, hormones, blood cells, and blood sugar levels in the body. Urine metanephrines testing is used to help detect or rule out the presence of a rare tumor called pheochromocytoma or a paraganglioma that releases excess metanephrines.

Stress Test

A stress test may be recommended by your doctor to determine the cause of your palpitations. This test allows a doctor to study your heart while the heart rate is elevated. This can be done by having the patient walk briskly on a treadmill or by administering medication that increases the heart rate.

Coronary Angiography

This modality helps check how blood flows through the heart and determines whether you have a blockage in the coronary artery that can result in symptoms such as heart palpitations. In this test, a contrast dye is injected into the arteries while the doctor observes the blood flow through the heart on an X-ray screen.

If your doctor doesn't suspect a medical condition behind the occurrence of palpitations, you may be advised to follow certain guidelines to help prevent them. These include:

• Identifying and avoiding triggers that cause palpitations. Maintain a log of activities that result in palpitations and try to avoid them. This may include the intake of caffeine, certain medications, and specific foods. Additionally, keep a note of your emotional state and events that trigger anxiety, which can lead to palpitations.
• Incorporating relaxation exercises into your daily routine to help manage stress and anxiety.
• Avoiding stimulants such as nicotine and recreational drugs.
• Incorporating regular exercise into your lifestyle.
• If you have low blood sugar, take your medications regularly and ensure that your blood sugar levels do not fall below the recommended level.
• Managing blood pressure and cholesterol levels.
• Following a healthy lifestyle and consuming a nutrient-rich diet.
• Avoiding smoking and the use of tobacco products.

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Generally, palpitations that aren't caused by an underlying medical condition tend to resolve on their own. If your doctor doesn't suspect a medical condition behind your palpitations, they might recommend the following steps to avoid the triggers that cause palpitations.

• Management of stress and anxiety: Incorporate relaxation techniques into your daily routine to help manage stress and anxiety. Consider daily physical activities, breathing exercises, yoga, or meditation.
• Avoiding stimulants: Palpitations can often occur after consuming products that stimulate the heart and cause a rapid heartbeat. It may be helpful to record the triggers that cause your palpitations and try to avoid them. Limiting caffeine intake or choosing decaffeinated beverages can be beneficial. Additionally, drugs such as cocaine and ecstasy are stimulants that can cause palpitations. Consult your doctor if you are taking any medications, as some may contain stimulants that can lead to heart palpitations.
• Eat a healthy diet: Low blood sugar is a leading risk factor for heart palpitations. Eating nutrient-rich foods and replacing simple carbohydrates with complex carbohydrates can help maintain stable blood sugar levels. Consider swapping fruit juices, white bread, and sugary drinks for whole grains and vegetables. If your palpitations are caused by a medical condition such as atrial fibrillation, your treatment will focus on addressing that condition.
• Medications to treat arrhythmia: Antiarrhythmic medications are used to convert an abnormal heartbeat into a normal rhythm and to prevent the recurrence of arrhythmia. Common antiarrhythmic drugs include amiodarone, adenosine, beta blockers, ibutilide, flecainide, and calcium channel blockers. Anticoagulant medications such as warfarin or aspirin may be prescribed to reduce the risk of blood clot formation.
• Electrical cardioversion: Individuals with persistent arrhythmias, such as atrial fibrillation, may require an invasive procedure called electrical cardioversion. This procedure is performed after administering short-acting anesthesia. An electrical impulse is delivered through the chest wall to help synchronize the heart and stabilize a normal heart rhythm.
• Radiofrequency ablation (RFA): Radiofrequency energy is utilized to destroy abnormal electrical pathways in the heart that contribute to arrhythmias. RFA is effective for conditions such as recurrent atrial flutter, atrial fibrillation, supraventricular tachycardia, atrial tachycardia, multifocal atrial tachycardia, and certain types of ventricular arrhythmia. An energy-emitting probe (electrode) at the tip of a catheter is placed into the heart, usually through a vein. The practitioner first maps the area of the heart to locate abnormal electrical activity (electrophysiology study) before eliminating the responsible tissue. Ablation has become the standard treatment for supraventricular tachycardia and typical atrial flutter, and it can also be used in atrial fibrillation to block the atrioventricular node after pacemaker implantation or to block conduction within the left atrium, especially around the pulmonary veins.

Here are a few things that you can follow at home to limit the occurrence or prevent palpitations:

• Reduce your caffeine intake and note the stimulants that result in palpitations.
• Practice relaxation techniques such as yoga and meditation to help manage stress and stabilize your mood.
• Try breathing exercises and deep relaxation techniques, such as aromatherapy.
• Incorporate regular exercise into your routine.
• Cease or limit smoking and avoid using products that contain nicotine.
• Avoid herbal and nutritional supplements that contain stimulants.
• Consult a mental health specialist if you experience mood disorders, such as panic attacks, anxiety disorder, or depression.
• Avoid eating spicy or rich foods that may cause heart palpitations.
• Label your medications and set an alarm to ensure you take them at the same time every day.
• Stick to the treatment plan prescribed by your doctor, and incorporate necessary lifestyle changes to help manage your condition and promote faster recovery.

Palpitations that do not resolve on their own and are caused by medical conditions can lead to certain complications if left untreated. These include:

• Fainting: Loss of consciousness can occur if the heart beats too rapidly, leading to a drop in blood pressure. The risk increases in individuals with congenital heart conditions or specific heart valve problems.
• Cardiac arrest: Palpitations may be caused by life-threatening heartbeat problems that can result in the heart stopping its effective beating.
• Stroke: If palpitations are due to a condition affecting the upper chambers of the heart, causing it to quiver instead of beating regularly, stroke can occur. This results from pooled blood forming clots; if a clot breaks, it can occlude a brain artery, leading to a potentially life-threatening stroke.
• Heart failure: Certain arrhythmias can significantly reduce the heart's ability to pump blood throughout the body. Heart function can be improved by controlling the rate of the arrhythmia causing heart failure.

If you have palpitations, these therapies can help you control the condition. They are:

• Exercising: Leading a healthy lifestyle and engaging in light exercises daily, such as walking, can aid in managing your medical condition. Consult your doctor about which exercises would be appropriate for you.
• Diet changes: Adopt a diet that is low in unhealthy carbohydrates and adhere to the protein guidelines provided by your doctor. The dietary recommendations will depend on the severity of your condition and the treatment regimen you are following. It is crucial to follow your doctor's advice, as your diet significantly influences your health.
• Yoga: Practicing simple exercises like yoga can help reduce stress and anxiety, which can positively impact your overall health.

Experiencing palpitations can be unsettling and may hinder your ability to perform daily tasks. However, modern medicine offers various options to help you maintain a healthy life and reduce the occurrence of irregular heart rhythms. In addition to medical treatments, incorporating lifestyle changes is essential for managing your condition. Here are a few tips to consider:

• Follow up with your doctor: Maintain regular communication with your doctor and report any changes in your palpitations. Contact your doctor if you notice any sudden changes in the nature of your palpitations or if you feel faint.
• Follow a healthy lifestyle: Implement the changes recommended by your doctor. This may include regular exercise and a balanced diet rich in fruits, vegetables, and whole grains.
• Take your medications regularly: If prescribed medications to regulate arrhythmia, ensure you take them consistently and keep your doctor informed about any changes in your condition.
• Manage stress and anxiety: If you are experiencing stress from work or personal relationships, practice relaxation techniques to help manage stress and anxiety.