Palpitations are sensations in which a person feels an irregular, hard, or rapid heartbeat. Palpitations at rest are often concerning for patients, since they come on for no apparent reason when the individual is not exerting themselves. There are many potential causes of palpitations including heart rhythm disorders, structural heart disease, medications, medical conditions, and lifestyle factors. Determining the cause of palpitations at rest requires a medical evaluation.
What are the common causes of palpitations at rest?
Some of the most common causes of palpitations at rest include:
- Premature atrial contractions (PACs)
- Premature ventricular contractions (PVCs)
- Atrial fibrillation
- Supraventricular tachycardia
- Ventricular tachycardia
- Structural heart disease like mitral valve prolapse or aortic stenosis
- Electrolyte abnormalities
- Thyroid disorders
- Anemia
- Low blood pressure
- Caffeine, nicotine, alcohol, recreational drugs
- Stress and anxiety
Let’s explore some of the most common causes in more detail.
Premature atrial and ventricular contractions
Premature contractions are extra beats that disrupt the regular heart rhythm. They originate from the atria (PACs) or the ventricles (PVCs). These extra beats are usually harmless and very common, especially as a person ages. PACs and PVCs can cause palpitations, fluttering sensations, skipped beats, or a pause before the next normal beat. They are more noticeable when the rest of the heart rhythm is slow, such as at rest.
Atrial fibrillation
Atrial fibrillation (AFib) is an irregular and rapid heart rhythm originating from the upper chambers of the heart. It is one of the most common heart rhythm disorders. In AFib, the atria quiver chaotically rather than contracting normally. This leads to an irregular and often rapid ventricular response, which causes palpitations. AFib episodes can come and go, or in severe cases be present all the time.
Supraventricular tachycardia
Supraventricular tachycardias (SVTs) are episodes of a rapid heart rate originating from above the ventricles. They often start and stop suddenly. SVTs can happen in people with and without underlying heart disease. The abrupt onset of a rapid rhythm can lead to noticeable palpitations, chest pain, shortness of breath, and other symptoms.
Ventricular tachycardia
Ventricular tachycardia (VT) occurs when there is a rapid heart rate originating from the lower chambers of the heart. It often causes palpitations that feel like pounding in the chest. Unlike SVT, ventricular tachycardia is a more dangerous arrhythmia and can progress to ventricular fibrillation and sudden cardiac arrest.
Structural heart disease
Structural abnormalities in the heart can also lead to palpitations at rest. Examples include mitral valve prolapse, aortic stenosis, atrial septal defects, and others. The abnormal structure causes turbulence in blood flow, which the person perceives as palpitations.
Electrolyte imbalances
Electrolytes are minerals in the blood that help regulate heart function. Low potassium, calcium, and magnesium levels can all trigger palpitations. Causes of electrolyte abnormalities include dehydration, certain medications, kidney disorders, thyroid disease, and poor nutrition.
Medications
Many prescription and over-the-counter medications list palpitations as a potential side effect. Some examples include asthma inhalers containing stimulants, certain cough and cold remedies containing pseudoephedrine, thyroid medications, and drugs for ADHD or depression. Always review the side effects of new medications with a doctor.
When should I see a doctor?
Occasional palpitations at rest may not require medical attention. However, scheduling an appointment is recommended if palpitations are:
- Frequent or prolonged
- Accompanied by lightheadedness, dizziness, or fainting
- Associated with chest pain or shortness of breath
- Causing significant distress or anxiety
Seeking prompt medical care is advised if palpitations are accompanied by:
- Loss of consciousness
- Seizure
- Not improving with rest
These signs can indicate a heart rhythm disturbance or other condition requiring urgent evaluation. Call emergency services for severe palpitations associated with chest pain, trouble breathing, or fainting.
How are palpitations diagnosed?
To determine the cause of palpitations, doctors use:
Medical history
Information about symptoms, family history, medications, medical conditions, and lifestyle provides helpful clues. Keeping a symptom diary with a log of palpitation episodes is useful.
Physical exam
This checks for signs of structural heart disease and clues about the origin of palpitations. Doctors listen closely to the heart rhythm.
Electrocardiogram (ECG)
An ECG records the electrical activity of the heart. It can detect abnormal heart rhythms, blocked arteries, or structural heart problems contributing to palpitations.
Holter or event monitor
These portable devices record the heart rhythm over an extended period. They improve the chances of capturing sporadic palpitations.
Echocardiogram
An echocardiogram uses ultrasound to visualize the heart’s structure and function. It can detect valve problems, enlarged chambers, blood flow issues, and muscle abnormalities.
Blood tests
Blood work helps identify electrolyte disturbances, thyroid disorders, anemia, and potential causes of structural heart disease.
Stress test
Monitored exercise on a treadmill can reveal abnormal heart rhythms triggered by exertion.
How are palpitations at rest treated?
Treatment depends on the underlying cause but may include:
Lifestyle changes
Limiting stimulants like caffeine, alcohol, and tobacco can reduce palpitations in some cases, as can managing stress and anxiety.
Medications
Drugs may regulate heart rhythms, slow rapid rates, improve blood pressure, or supplement electrolytes.
Surgery
Procedures to destroy abnormal electrical pathways or implant devices like pacemakers may be options for some arrhythmias.
Ablation therapy
Catheter ablation targets small areas in the heart generating abnormal rhythms. This minimally invasive approach offers a cure for some arrhythmias.
Treatment of underlying condition
Targeting conditions leading to palpitations, such as thyroid disorders, anemia, or structural heart defects can help reduce symptoms.
What lifestyle changes help manage palpitations?
These self-care tips can lessen palpitations:
- Cut back on stimulants like caffeine, tobacco, alcohol, and illicit drugs
- Reduce stress through relaxation techniques, meditation, yoga, or counseling
- Increase physical activity with regular aerobic exercise
- Follow a heart healthy diet low in sodium, added sugars, and trans fats
- Stay well hydrated by drinking plenty of water
- Use over-the-counter electrolyte supplements if deficient in potassium or magnesium
- Take medications that provoke palpitations only when necessary
- Practice deep breathing at onset of palpitations to stimulate the vagus nerve and slow the heart rate
Making key lifestyle changes can lessen troubling symptoms of palpitations at rest in many cases. But recurrent or concerning palpitations still warrant medical evaluation to identify and properly treat the underlying cause.
Conclusion
Palpitations at rest are disconcerting but usually not dangerous. Brief episodes may be caused by premature heartbeats or stress. However, frequent or prolonged palpitations, those impairing quality of life, or palpitations with concerning symptoms should be medically evaluated. Cardiac monitoring, blood tests, imaging, and other diagnostic tests help identify the cause. Underlying arrhythmias, structural heart disorders, systemic conditions, electrolyte imbalances, and medications are common culprits. Lifestyle changes combined with medical treatment of causative factors can provide great relief by controlling or eliminating symptoms. But sudden or severe palpitations require prompt medical care to check for serious cardiac conditions requiring urgent intervention.
