Heart palpitations are sensations of an abnormally strong, rapid, or irregular heartbeat, often felt as a brief flutter, a skipped beat, or a forceful pounding in the chest, throat, or neck. Since most people are generally unaware of their heart rhythm, becoming conscious of it can be unsettling. While these sensations are common and often harmless, they can occasionally signify a more serious underlying health issue. Understanding the distinction between a benign occurrence and a potentially significant event is crucial for knowing when to seek medical attention.
Everyday Causes That Are Not Serious
Temporary episodes of heart palpitations are triggered by external or lifestyle factors that do not indicate primary heart disease. These occurrences often result from the heart reacting to stimulants or temporary physiological stress. High intake of caffeine can increase heart rate and cause rhythm disturbance. Similarly, nicotine acts as a stimulant that can provoke palpitations by constricting blood vessels and elevating blood pressure.
Intense physical exercise naturally increases the heart rate to meet the body’s demand for oxygen, and the sudden awareness of this forceful beat can be perceived as a palpitation. Strong emotional states, such as anxiety, fear, or a panic attack, trigger a release of stress hormones like adrenaline. This hormonal surge activates the body’s fight-or-flight response, causing an abrupt acceleration of the heart rate.
Hormonal changes can also play a role, particularly during menstruation, pregnancy, or menopause, as fluctuations in estrogen levels affect the cardiovascular system. Dehydration and low blood sugar can disrupt the body’s balance and lead to transient palpitations. Certain over-the-counter medications, such as decongestants or some asthma inhalers, list palpitations as a common side effect due to their stimulant properties.
Immediate Warning Signs Requiring Emergency Care
Palpitations occurring alongside specific, severe symptoms demand immediate emergency medical attention. Symptoms indicating inadequate blood flow suggest a potentially life-threatening event. Severe chest pain or pressure, radiating to the jaw, neck, or arm, is a concerning sign that could indicate a heart attack.
Unexplained fainting (syncope) or severe dizziness suggests the heart is not pumping enough blood to the brain. This signals a dangerously fast or slow heart rhythm that compromises cardiac output. Severe shortness of breath, especially without exertion, should prompt an emergency response, as it may signal heart failure.
Palpitations that are prolonged, lasting for many minutes, or those that occur at complete rest, require urgent evaluation. Any new or worsening pattern of palpitations, especially in individuals with known heart disease, must be treated seriously. These acute presentations require rapid diagnostic testing and intervention to stabilize the heart rhythm.
Underlying Medical Conditions
Recurring palpitations without acute emergency symptoms may indicate a chronic medical condition requiring investigation. Arrhythmias, or abnormal heart rhythms, are a primary cause, including Atrial Fibrillation (AFib). In AFib, the upper chambers of the heart quiver instead of beating effectively, leading to a rapid and irregular pulse.
Structural heart disease, such as problems with heart valves or a thickened heart muscle (cardiomyopathy), can alter blood flow dynamics and generate irregular electrical signals. These physical abnormalities place stress on the heart, increasing the likelihood of rhythm disturbances. Systemic conditions impacting the entire body can also affect heart rhythm.
An overactive thyroid gland (hyperthyroidism) floods the body with excess thyroid hormone, acting as a stimulant that causes a persistently rapid heart rate. Blood disorders like anemia, or imbalances in electrolytes like potassium and magnesium, can destabilize the heart’s electrical system. These underlying causes necessitate a formal diagnosis for long-term treatment.
Seeking Professional Medical Advice
If palpitations are frequent, persistent, or cause significant concern, consulting a primary care physician or cardiologist is the appropriate next step. Before the appointment, track specific details about the episodes, including frequency, duration, and preceding triggers like foods or activities. This detailed history provides the medical professional with important context.
The initial evaluation involves a physical exam and a 12-lead electrocardiogram (ECG) to capture the heart’s electrical activity at rest. Since palpitations are often intermittent, a physician may recommend ambulatory monitoring to record the heart rhythm over a longer period. A Holter monitor is worn for 24 to 48 hours, while an event recorder can be worn for up to a month to capture a symptomatic episode.
Blood tests check for non-cardiac causes like anemia, thyroid hormone levels, or electrolyte abnormalities. An echocardiogram (ultrasound of the heart) assesses the heart’s structure and function, ruling out valve issues or cardiomyopathy. These diagnostic tools correlate symptoms with a specific heart rhythm or underlying condition, guiding the management plan.