Heart palpitations are the sensation of an unusually noticeable heartbeat, often described as a racing, pounding, fluttering, or skipped beat. This feeling can occur in the chest, neck, or throat. While often unsettling, palpitations are a common symptom that is not always indicative of a serious problem. Determining whether this symptom warrants an immediate trip to the emergency room or a routine appointment depends on the presence of other accompanying symptoms and the duration of the episode.
Urgent Symptoms Demanding Immediate Emergency Care
The presence of palpitations alongside specific, alarming symptoms indicates that the heart’s electrical system or blood flow may be compromised, requiring immediate medical intervention. Call emergency services or go to the nearest emergency department right away if palpitations are accompanied by chest pain, pressure, or tightness. This discomfort may spread to the arms, neck, jaw, upper back, or stomach, suggesting a possible acute cardiac event.
Severe shortness of breath or difficulty breathing is a serious sign, indicating the heart may not be effectively pumping blood and oxygen. A sudden onset of severe dizziness, lightheadedness, or feeling faint should also prompt an immediate emergency visit. Fainting (syncope) or a loss of consciousness suggests dangerously low blood flow to the brain, potentially caused by a life-threatening arrhythmia.
Confusion, unusual sweating, or a heart rate that feels extremely rapid and sustained for more than a few minutes are also red flags. If you have a known history of heart disease, any new or worsening palpitations should necessitate an emergency evaluation. It is safer to call for an ambulance rather than attempting to drive yourself.
Palpitation Triggers That Are Not Emergencies
Many episodes of heart palpitations are not linked to a heart problem and are instead caused by external or physiological triggers. Stimulants are a common culprit, including excessive consumption of caffeine, nicotine products, and alcohol. Certain over-the-counter medications, particularly decongestants containing pseudoephedrine, can also trigger an increased heart rate.
Emotional states and mental health play a significant role, as stress, anxiety, and panic attacks often cause temporary palpitations. These episodes occur due to the body’s release of stress hormones.
Other non-cardiac causes include physiological imbalances like dehydration, low blood sugar, or anemia. Hormonal shifts during pregnancy, menstruation, or menopause can also be responsible. Intense physical activity may also cause a temporary awareness of the heartbeat. While these triggers do not constitute a medical emergency, persistent or frequent palpitations should still be discussed with a healthcare provider.
What Happens When You Arrive at the Emergency Room
Upon arrival at the emergency room, you will first undergo a triage process to assess the urgency of your condition. A nurse will take your vital signs, including blood pressure, pulse rate, and oxygen saturation, to determine your stability. The immediate diagnostic step is a 12-lead Electrocardiogram (ECG or EKG), which records the electrical activity of your heart to identify any abnormal heart rhythms (arrhythmias).
Blood tests are routinely ordered to check for factors causing palpitations or indicating heart damage. These include checking electrolyte levels (potassium and magnesium) and measuring cardiac enzymes like Troponin to determine if the heart muscle has been injured. The physician may also order a chest X-ray or continuous cardiac monitoring to observe for recurrent episodes.
Next Steps for Non-Urgent Symptoms
If your heart palpitations are brief, infrequent, and occur without any urgent accompanying symptoms, schedule an appointment with your primary care physician. Your doctor will discuss your medical history, potential triggers, and perform a physical exam to look for signs of non-cardiac causes, such as an overactive thyroid gland.
To capture the heart rhythm over a longer period, an outpatient diagnostic tool such as a Holter monitor may be prescribed. This portable device continuously records the heart’s electrical activity for 24 to 48 hours. If palpitations occur less frequently, an event recorder may be used, which you activate only when you feel the symptoms.
In addition to medical testing, implementing lifestyle modifications is often advised, such as reducing or eliminating known triggers like excessive caffeine, alcohol, and nicotine. Stress reduction techniques like deep breathing or yoga can also help manage episodes linked to anxiety.