Heart palpitations refer to feelings of a rapid, fluttering heartbeat or a skipped beat. They can occur occasionally in healthy people and are usually not a cause for concern. However, frequent or prolonged palpitations may indicate an underlying heart condition and require medical evaluation. In this article, we will explore the common sensations associated with heart palpitations and discuss when to see a doctor.
What does a palpitation feel like?
People describe palpitations in different ways, but some of the most common sensations are:
- Fluttering in the chest
- Racing or pounding heartbeat
- Skipped beats or missed beats
- Heartbeat that is too hard or too fast
- Thumping in the chest
Palpitations can occur with exercise and stress. In these cases, the heartbeat may feel like it is fluttering rapidly or thumping forcefully. Palpitations at rest may feel like the heart is skipping beats or pausing briefly.
Fluttering
A fluttering sensation in the chest is one of the most common symptoms of palpitations. It may feel like the heart is beating too lightly and quickly, similar to butterflies in the stomach. Fluttering palpitations may indicate:
- Atrial fibrillation – Irregular quivering of the upper heart chambers
- Premature atrial contractions (PACs) – Early extra beats originating in the atria
- Premature ventricular contractions (PVCs) – Early extra beats originating in the ventricles
Pounding
A pounding heartbeat describes a strong, forceful pulsation or thumping sensation in the chest. It may feel like the heart is beating too hard. Possible causes include:
- Physical exercise
- Emotional stress and anxiety
- Fever
- Anemia – Low red blood cell count
- Hyperthyroidism – Overactive thyroid
- High blood pressure
Racing
A racing heartbeat is when the heart feels like it is beating too rapidly, even when at rest. This sensation may indicate:
- Panic attacks and high anxiety
- Sympathomimetic drugs, like amphetamines
- Low blood pressure
- Heart problems such as heart failure
- Anemia
- Hyperthyroidism
Missed beats
Missed or skipped beats are a common palpitation sensation. It may feel like the heart suddenly stops or pause briefly before resuming again with a big beat. Causes can include:
- Premature contractions (PACs and PVCs)
- Sinus node dysfunction – Irregular electrical signals from the sinus node
- Benign ectopic beats – Harmless extra beats
In most cases, occasional missed beats are normal and not concerning. Frequent skipped beats may require medical evaluation.
When palpitations may indicate a heart problem
While palpitations are frequently benign, they can sometimes be a sign of an underlying heart condition. Contact your doctor if palpitations are accompanied by:
- Lightheadedness, dizziness or fainting
- Shortness of breath
- Chest pain or tightness
- Heart murmur or unusual heartbeat sound
- Family history of heart problems or sudden death
Seek emergency care if palpitations occur with:
- Loss of consciousness
- Seizure
- Severe chest pain
- Very rapid, racing heartbeat
These symptoms can indicate a serious heart condition like an arrhythmia, heart attack, or other cardiovascular emergency.
Common causes of palpitations
Benign ectopic beats
Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are extra beats that seem to interrupt the normal heart rhythm with a fluttery or skipped beat. They are very common, especially with caffeine, fatigue, and stress.
Atrial and ventricular arrhythmias
Abnormal electrical signals in the upper (atrial) or lower (ventricular) heart chambers can trigger rhythm disorders like atrial fibrillation, ventricular tachycardia, and more. These may cause noticeable palpitations.
Medications
Many medications, including decongestants, stimulants, bronchodilators, and certain antidepressants can increase heart rate and bring on palpitations as a side effect.
Caffeine, alcohol, and nicotine
Beverages, foods, and substances containing caffeine, alcohol or nicotine can stimulate the heart and precipitate palpitations in sensitive individuals.
Strenuous exercise
Intense physical exertion and sports training places greater demands on the cardiovascular system. The increased heart rate can produce pounding or fluttering palpitations.
Stress and anxiety
Stress hormones like adrenaline can accelerate the heart rate and trigger anxious feelings associated with palpitations. Panic attacks may also cause palpitations.
Hormonal changes
Shifting estrogen and progesterone levels during the menstrual cycle, pregnancy, and perimenopause can affect the heart’s electrical activity and sometimes trigger palpitations.
Sleep deprivation
Lack of sleep can disrupt the body’s circadian rhythms and contribute to stress and fatigue. This may result in palpitations and more noticeable heartbeats.
Thyroid disorders
Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can influence heart rate and rhythm and cause palpitations.
Anemia
Anemia refers to a lack of healthy red blood cells in the body. Heart palpitations may develop as the circulatory system works harder to compensate for reduced oxygen delivery.
Cardiomyopathy
Enlargement, thickening, or stiffening of the heart muscle (cardiomyopathy) can change the heart’s structure and electrical signaling, leading to palpitations.
Congenital heart defects
Some people are born with structural abnormalities in the heart that may increase the risk for arrhythmias and palpitations later in life.
Diagnosing the cause
Doctors use a combination of the medical history, physical examination, tests and procedures to diagnose palpitations:
Medical history
The doctor asks about your palpitations and gathers information about symptoms, family history, medications, health behaviors, and other chronic conditions. Details help pinpoint a possible cause.
Physical exam
The physician listens to your heart sounds, feels for murmurs, checks your pulse, blood pressure, and thyroid. Signs may point to an underlying problem.
Electrocardiogram (ECG)
ECG records the electrical signals during heartbeats. It can detect abnormal rhythms, premature contractions, and more to explain palpitations.
Holter monitoring
This involves wearing a portable ECG device for 24 to 72 hours during normal activity. It documents your heart rhythm over time to capture intermittent palpitations.
Echocardiogram
Echocardiogram uses ultrasound to visualize cardiac structure and function. It checks for structural defects, muscle problems, valve issues and more.
Blood tests
Blood work examines cells counts, thyroid hormones, electrolytes, and cardiac enzymes for signs of anemia, thyroid issues, or heart damage causing palps.
Prevention
You may be able to reduce palpitations by:
- Reducing stimulants like caffeine, alcohol, and tobacco
- Managing stress through relaxation exercises, meditation, etc.
- Exercising regularly but avoiding overexertion
- Treating underlying medical conditions, like thyroid disorders
- Avoiding certain medications that cause palpitations, when possible
However, many cases of palpitations cannot be prevented entirely. But staying healthy and managing medical issues can help reduce their frequency and intensity.
Treatment
Treatment depends on the underlying cause but may involve:
Lifestyle changes
Improving sleep, limiting stimulants, exercising moderately, and reducing stress can minimize palpitations in some cases.
Medications
Drugs like beta-blockers, calcium channel blockers, and antiarrhythmics help control abnormal heart rhythms and palpitations in some heart conditions.
Surgery
Procedures like catheter ablation destroy small areas of heart tissue causing rhythm problems. This stops abnormal electrical signals that produce palpitations.
Implanted devices
A pacemaker or cardioverter defibrillator can regulate heart rate and rhythm abnormalities causing severe, recurrent palpitations.
Mild palpitations usually do not require treatment beyond lifestyle changes. But significant, chronic palpitations should be evaluated to identify any serious heart condition requiring specific medical care.
When to see a doctor
Consult your physician if you experience frequent palpitations or any worrying symptoms, like:
- Palpitations that come on suddenly and feel more intense
- Lightheadedness or dizziness
- Shortness of breath
- Chest pain or tightness
- Fainting or near fainting
See a cardiologist to investigate the cause, assess your risk, and create an appropriate treatment plan for your palpitations. Prompt medical care is especially important if you have an underlying heart condition.
Conclusion
Heart palpitations involve sensations of fluttering, pounding, racing, or skipped heartbeats. They are often harmless but can result from arrhythmias, heart disease, medications, and other medical disorders.
Seeking timely medical care is recommended if palpitations are frequent, intense, or accompanied by other cardiac symptoms. Diagnostic tests help identify any serious heart condition requiring treatment. With evaluation and proper care, most people with palpitations can manage their symptoms and prevent complications.
