Heart palpitations can also be a side effect of certain medications and other substances, such as caffeine and nicotine.
This article describes the different ways you might experience heart palpitations, why you may be having them, and how a doctor will diagnose and, if necessary, treat the underlying cause.
Heart Palpitation Symptoms
People experience heart palpitations in different ways. Among the most common are:
The sensation of the heart skipping a beatA heartbeat that sometimes feels too strongRapid irregular heartbeatsIrregular heartbeats
These sensations are all felt in the chest. Some people with a specific type of heart arrhythmia called atrioventricular node reentrant tachycardia (AVNRT) notice palpations in their neck.
Causes
While heart arrhythmias are a common cause of palpitations, there are a number of health conditions, medications, and other substances that can make the heart beat abnormally.
Arrhythmias
Most any type of heart arrhythmia can cause palpitations. The most common are not dangerous. They include premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).
However, some palpitations are caused by dangerous arrhythmias, such as ventricular tachycardia.
When palpitations have a cardiac cause, they’re most likely to occur in people who have heart disease or who experience palpitations at work or during sleep.
Other Medical Conditions
Other health problems that may cause heart palpitations include:
AnxietyAnemiaOveractive thyroidPregnancyDehydrationLow carbon dioxideShockLow blood sugar (hypoglycemia)Abnormal levels of potassium or magnesiumBlood loss
Medications and Other Substances
Certain over-the-counter (OTC) and prescription drugs are associated with heart palpitations, as are some legal and illegal substances. Among them:
Cough and cold medicationsDecongestantsDiet pillsBeta-blockersSome herbal supplementsAsthma inhalersThyroid medicationsCaffeineNicotineAlcoholIllegal drugs such as cocaine and amphetamines
Diagnosis
If you have heart palpitations, your cardiologist will do an electrocardiogram (ECG), a test that measures the electrical activity of the heart. It produces what’s known as a tracing of the heart’s rhythm, which looks like squiggly lines on a long sheet of special paper.
An ECG can tell your doctor if a heart rhythm disturbance is causing your palpitations and help them identify the particular type of arrhythmia it is.
In order to diagnose a heart arrhythmia correctly, the palpitations have to be captured in real time during the test. This can be tricky if your palpitations happen sporadically.
In this case, your cardiologist may do what’s called ambulatory electrocardiographic monitoring (AECG). Ambulatory monitoring systems involve attaching the monitor to your body as you go about your day.
There are several types of ambulatory monitoring. They include:
Holter monitoring, which records heart rhythms over 24 to 48 hours or for up to several weeks An event monitor, which is a portable ECG device that is used only while symptoms are occurring An implantable loop recorder, which involves minor surgery to place a device in the chest to monitor heart rhythms for up to three years
Treatment
Heart arrhythmias that cause palpitations often do not need to be treated. An important exception is ventricular tachycardia, which can lead to cardiac arrest and even death if not addressed.
When a heart arrhythmia does require treatment, the options include:
Antiarrhythmic medications that directly affect the heart to help it beat normally, including Betapace (sotalol), Tambocor (flecainide, now only available as a generic drug), Rythmol (propafenone), and Pacerone (amiodarone)Calcium channel blockers: Blood pressure medications that prevent calcium from getting into the heart, blood vessels, and pancreasBeta-blockers: Medications that block certain hormones such as adrenaline that cause the heart rate to speed up and blood vessels to narrowAnticoagulants: Drugs that thin the blood and prevent it from clottingRadiofrequency ablation: A procedure in which a type of energy similar to the energy given off by a microwave is used to destroy the areas of the heart causing an irregular heartbeatAn implantable cardioverter defibrillator (ICD): A device implanted under the skin that is connected to the heart with wires. The ICD tracks the heart rate. If it becomes irregular, it will use an electric shock to make the heart beat normally.
If something other than an arrhythmia is causing heart palpitations, the treatment will depend on what it is. This can mean anti-anxiety medication and therapy for someone who has palpitations due to extreme anxiety, for example, or treatment for a condition such as hyperthyroidism or low blood sugar.
When a prescribed medication is to blame for heart palpitations, changing the dose or switching to another drug may stop them from happening. Never do this without consulting with your doctor first.
Cutting back on caffeine or alcohol, quitting smoking, and steering clear of OTC or illicit drugs, when any of these cause palpitations, should also prevent them.
Summary
Heart palpitations are noticeable changes in the way the heart beats. They can be caused by an irregular heart (arrhythmia), other health conditions, certain medications, and caffeine, nicotine, and illegal drugs.
To diagnose palpitations related to a heart problem, a cardiologist will do an ECG or other form of heart rhythm monitoring.
Treatment for heart palpitations will depend on the cause. You may simply need to make lifestyle changes like cutting back on coffee or quitting smoking. Or you may need to take medication, adjust your current medications, or undergo a procedure to help your heart maintain a normal rhythm.
A Word From Verywell
Feeling your heart seem to skip a beat or beat faster or slower than usual can be unsettling, to say the least.
If this happens to you, unless you’ve already been diagnosed with a cardiac condition, the likelihood you have a serious heart problem is relatively low. It may be you’ve simply downed too much coffee or the decongestant you took for a stuffy nose is affecting your heart rate.
To be sure, call your healthcare provider. They will be able to figure out what’s going on and, if you do have a medical issue, get you the treatment you need.
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