A flip-flopping or pounding sensation in your chest. A racing or erratic heartbeat. You’re experiencing heart palpitations.
Cleveland Clinic electrophysiologist Jeffery Courson, DO, hears about these episodes all the time. In fact, on a recent day, he reviewed about 20 messages from patients reporting concerns about palpitations.
“It’s an incredibly common symptom and concern,” Dr. Courson says. “When they become more concerning, that’s when people reach out to their doctor or seek specialty care.”
Not all heart palpitations require medical attention, but if their frequency or intensity increases, they’re accompanied by other symptoms or they’re causing you consternation, seek help from your doctor.
What Are Heart Palpitations?
The term “heart palpitation” describes the subjective feeling of irregularities in your heart’s rate or rhythm. For some people, a palpitation manifests as a flip-flopping or fluttering feeling in the chest. For others, it’s a racing, slow or irregular heart rate, a pounding sensation or a skipped beat. People often notice heart palpitations when they’re lying down and undistracted, but they can occur at any time.
“You might be more aware of them when you lie on your left side and less aware of them when you lie on your back or right side,” Dr. Courson says. “A lot of that is from the pressure of your body on your chest and how that affects your heart inside the chest wall.”
What Causes Heart Palpitations?
Heart palpitations usually are no cause for alarm and signal relatively benign conditions, such as premature ventricular contractions (PVCs), in which the electrical impulse that sparks a heartbeat originates in the heart’s lower chambers (ventricles) instead of in the right atrium, or from minor heart-rhythm abnormalities (arrhythmias), Dr. Courson says.
Palpitations may occur with stress/anxiety, a lack of sleep, or overuse of caffeine, alcohol or nicotine. Furthermore, a wide range of medications—for example, certain antidepressants and blood pressure medicines, stimulants, decongestants and asthma inhalers—can cause heart palpitations.
When to Worry About Heart Palpitations
In some cases, heart palpitations may indicate more concerning cardiac arrhythmias, such as atrial fibrillation (A-fib) or ventricular tachycardia, a potentially life-threatening rapid heartbeat that originates in the ventricles. Additionally, they may be a sign of a heart-valve abnormality, thyroid disease, electrolyte imbalances (especially potassium or magnesium insufficiencies), low blood sugar or anemia.
“Every single person has palpitations, and when we’re healthy and they’re mild or infrequent and they’re not causing harm, we tend to ignore them. I think that’s OK in those situations,” Dr. Courson advises. “When they require more attention is when there’s a change: if you’ve never had this type of palpitation before or it’s much worse, lasting longer or occurring more frequently. And especially if there are associated symptoms, like shortness of breath, lightheadedness, passing out or chest pain, if it’s a frightening or severe symptom, call 9-1-1.”
If you’re experiencing heart palpitations, take note of your symptoms. Then, answer these questions and share your answers with your doctor:
- For how long have you been experiencing palpitations?
- How frequently do they occur?
- How long do these episodes typically last?
- What do the palpitations feel like?
- Do you experience any other symptoms with them, such as shortness of breath, lightheadedness or chest pain?
How to Stop Heart Palpitations
To diagnose the cause of your palpitations, your doctor will recommend an electrocardiogram (EKG), and you might be given a portable monitor that records your heart rate and rhythm throughout the day.
Smartwatches and other wearable technology can record your heart rate and rhythm and alert you and your doctor to potential abnormalities. “Sometimes, I tell patients if they get another episode of palpitations, to record it on their watch and then send it to me,” Dr. Courson says. “The quality of the recordings is comparable to medical grade, but they’re not really good at filtering out what’s important and not important, so you have to look at the EKGs. You can use smartwatches as a tool, but they’re not reliable enough to guide important medical decisions.”
For heart palpitations that affect your quality of life, your doctor may prescribe beta-blockers or calcium channel blockers, medications that have beneficial effects on the heart’s electrical system. If serious arrhythmias are causing palpitations, your physician may prescribe potent antiarrhythmic drugs or recommend catheter ablation to destroy tissue in the heart that’s triggering the episodes.
“For many patients with minor, benign palpitations, a little reassurance may be all you need, just to understand what’s causing the symptom, that it’s not dangerous and that you don’t need medical therapy,” Dr. Courson says. “Unless somebody is having severe symptoms, number one, don’t panic, and number two, don’t ignore it. Seek care and treatment. We can identify most of the things that cause heart palpitations, and once we know what the underlying cause is, we can determine what’s the best course of management.”
