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Can low iron cause heart palpitations?


Heart palpitations are an abnormal awareness of the heartbeat, characterized by a sensation that the heart is racing, fluttering, pounding, or skipping beats. While often harmless, heart palpitations can sometimes be a sign of an underlying heart condition and cause distress or anxiety in those experiencing them. One potential cause of heart palpitations that is sometimes overlooked is low iron levels, also known as iron deficiency or anemia. In this article, we’ll explore the link between low iron and heart palpitations and provide an overview of the evidence behind whether iron deficiency can trigger heart rhythm abnormalities.

What causes heart palpitations?

The heart’s regular rhythmic heartbeat is controlled by electrical signals that coordinate the heart’s pumping action. When the electrical system is disrupted or stimulated abnormally, it can cause extra or irregular heartbeats, known as arrhythmias or dysrhythmias. These manifest as palpitations or fluttering sensations in the chest.

Some common causes of heart palpitations include:

  • Stress and anxiety
  • Caffeine, alcohol, nicotine
  • Vigorous exercise
  • Low blood sugar
  • Fever or illness
  • Medication side effects
  • Hormonal changes
  • Heart disease, such as coronary artery disease or valvular heart disease
  • Abnormal heart rhythms (arrhythmias), like atrial fibrillation
  • Electrolyte imbalances

Palpitations are very common, affecting up to 70% of adults at some point. While frightening, the vast majority of palpitations are harmless and require no specific treatment. However, recurrent or prolonged palpitations should be evaluated by a doctor to identify any potential underlying causes.

Can low iron levels cause heart palpitations?

There is evidence that iron deficiency, with or without anemia, may be associated with heart palpitations and other heart rhythm disturbances. Let’s look at the evidence:

Studies on iron deficiency and arrhythmias

Several studies have found associations between iron deficiency and abnormal heart rhythms, including:

– A study of young women found those with iron deficiency were 3-4 times more likely to experience palpitations and pounding heart sensations. The lower their iron levels, the more frequent their symptoms.

– Multiple studies in patients with heart failure found that 50-70% of patients were iron deficient. The severity of their iron deficiency correlated with a higher likelihood of experiencing atrial fibrillation and other arrhythmias.

– A study in patients undergoing kidney dialysis found that iron deficiency was associated with a 3-fold higher risk of sudden cardiac death related to heart rhythm abnormalities. Treating iron deficiency reduced this risk.

Proposed mechanisms

Researchers have proposed several ways in which low iron levels may contribute to heart rhythm disturbances:

  • Iron is essential for energy production in heart cells. Iron deficiency reduces available energy for cardiac cells, which may impair heart function.
  • Lack of iron leads to reduced oxygen supply to tissues (hypoxia). Low oxygen levels affect ion channels in heart cells, altering electrical conduction.
  • Iron is needed to synthesize heart proteins involved in cardiac muscle contraction. Iron deficiency may impair heart pumping action.
  • Low iron causes higher levels of catecholamines like adrenaline. These stress hormones may stimulate arrhythmias.

However, the mechanisms linking low iron and palpitations are still not fully understood.

Who is at risk of low iron causing palpitations?

Certain individuals appear to be at higher risk of heart rhythm issues from iron deficiency:

  • Women – Due to blood loss from menstruation, iron deficiency is more common in women.
  • Pregnant women – Iron needs increase during pregnancy, increasing demand.
  • Endurance athletes – Strenuous exercise may cause intestinal bleeding and iron loss.
  • Vegans/vegetarians – As iron is primarily obtained from meat, non-meat diets increase deficiency risk.
  • Patients with chronic conditions causing inflammation or bleeding, like inflammatory bowel disease, kidney failure, or cancer.
  • Frequent blood donors – Donating blood reduces body iron stores.

However, anyone with inadequate iron intake, absorption issues, or excess blood loss could potentially develop iron deficiency and be predisposed to associated heart rhythm issues.

Symptoms of iron deficiency

Common symptoms of iron deficiency include:

  • Fatigue, weakness
  • Shortness of breath
  • Rapid heart rate
  • Palpitations
  • Chest pain
  • Headache
  • Dizziness
  • Pale skin
  • Dry, damaged hair and nails

However, symptoms may develop gradually and be vague. Many with iron deficiency have no symptoms initially.

Having risk factors for iron deficiency combined with recurrent palpitations or pounding heart sensations should raise suspicion for low iron levels.

Diagnosing iron deficiency

Iron deficiency is diagnosed with blood tests including:

  • Complete blood count (CBC) – Checks hemoglobin and hematocrit levels. Low levels indicate anemia.
  • Ferritin – Measures stored iron levels. Ferritin < 12-15 ng/mL is iron deficiency.
  • Iron, total iron binding capacity (TIBC), transferrin – Evaluate iron transport and blood levels.
  • Soluble transferrin receptor – Increases when iron demand by tissues is high.

In addition to the above tests, doctors also look for potential causes of iron deficiency like heavy menstrual bleeding, gastrointestinal sources of bleeding, or malabsorption conditions.

Treating iron deficiency

Treating the underlying cause of iron deficiency is key. Additionally, oral iron supplements are used to restore normal iron levels:

  • Ferrous sulfate, ferrous gluconate, ferrous fumarate – Common iron salt forms used to treat deficiency.
  • Iron is best absorbed on an empty stomach with vitamin C.
  • Supplements can cause side effects like abdominal discomfort, constipation, nausea, dark stools.
  • Intravenous iron infusions may be used for severe, refractory deficiency.
  • Food sources include red meat, eggs, spinach, nuts, fortified cereals.
  • Treating deficiency and anemia can help resolve associated palpitations.

restoring adequate iron levels is recommended for those with unexplained palpitations, particularly in the context of additional iron deficiency symptoms.

When to see a doctor

You should speak to your doctor if you experience any of the following:

– Frequent or prolonged heart palpitations

– Palpitations combined with chest pain, difficulty breathing, fainting

– Known risk factors for iron deficiency like vegetarian diet, heavy periods, or frequent blood donation

– Fatigue, weakness, pale skin, hair loss, brittle nails

– Family history of anemia

Testing can help determine if iron deficiency could be contributing to palpitations. Your doctor can advise on appropriate iron testing and optimal treatment approaches.

Other causes of palpitations

While iron deficiency is one potential cause, palpitations often result from other common triggers like:

Medications

Medication Examples
Asthma inhalers Albuterol, salmeterol
Decongestants Pseudoephedrine, phenylephrine
Stimulants Amphetamines, cocaine
Caffeine Coffee, tea, soda, energy drinks

Substance use

  • Alcohol, especially binge drinking
  • Nicotine
  • Cocaine, methamphetamines
  • Marijuana

Medical conditions

  • Heart disease – Coronary artery disease, heart attack, heart failure
  • Heart valve disorders like mitral valve prolapse
  • Electrolyte disturbances – High/low potassium, magnesium, calcium
  • Thyroid disorders – Hyperthyroidism, hypothyroidism
  • Anemia – From causes besides iron deficiency

Physiological factors

  • Exercise, especially high intensity
  • Dehydration
  • Fever
  • Pregnancy
  • Stress, anxiety

Cardiac arrhythmias

  • Premature ventricular contractions (PVCs)
  • Premature atrial contractions (PACs)
  • Supraventricular tachycardia (SVT)
  • Atrial fibrillation

Diagnostic testing like EKGs, holter monitors, or event monitors can help identify arrhythmic causes of palpitations.

When are palpitations serious?

Most palpitations are not concerning. However, prompt medical evaluation is recommended if palpitations occur alongside:

  • Chest pain or pressure
  • Shortness of breath
  • Lightheadedness, near-fainting or fainting
  • Known heart disease or arrhythmias

These symptoms can indicate an arrhythmia, structural heart disease, or other cardiac issues requiring urgent diagnosis and treatment.

Conclusion

Iron deficiency and resulting anemia is one possible cause of heart palpitations and rhythm abnormalities, though the mechanisms linking low iron and arrhythmias are incompletely understood. Those with frequent palpitations, especially in the context of iron deficiency risk factors, should be evaluated for reduced iron levels and anemia. Restoring normal iron levels may help resolve associated heart symptoms. However, palpitations often result from other common causes like medication use, recreational drugs, physiological stress, or benign arrhythmias. Evaluation by a doctor can help determine whether palpitations are related to low iron versus other cardiac or systemic conditions necessitating specific treatment.