By Sabahat Bokhari, M.D.
Have you ever felt as if your heart skipped a beat or that it was beating so hard that it could beat straight out of your chest?
These feelings are called heart palpitations, and while they can be unnerving, they are often harmless.
However, in some instances, heart palpitations can be due to an abnormal heart rhythm that may require medical treatment.
If you experience heart palpitations, see your doctor. A thorough evaluation can help determine the cause and identify any underlying medical issues.
What are heart palpitations?
Controlled by electrical impulses, your heart normally beats between 60 and 100 times per minute, keeping blood pumping throughout your body at a steady rhythm.
Every now and then, these electrical impulses can be interrupted, briefly changing the heart’s rhythm.
When this happens, you may feel a flutter in your chest or feel as if your heart skipped a beat.
You might feel your heart is beating too fast or even too slow, and you might also have an acute awareness of your heartbeat.
These are heart palpitations and are a common occurrence that can be due to the following:
• Anxiety, stress, panic attack or fear
• Caffeine
• Nicotine
• Cocaine or other illegal drugs
• Diet pills
• Exercise
• Fever
Usually, heart palpitations are not serious and resolve on their own, but occasionally they can signal an ongoing arrhythmia or abnormal heart rhythm that can cause the heart to pump less effectively.
There are several different types of arrhythmias, which are classified by where in the heart they originate – the upper chambers (atria) or lower chambers (ventricles).
Common arrhythmias include:
• Atrial fibrillation or atrial flutter, characterized by a fast and irregular heartbeat. Atrial fibrillation can lead to serious complications such as stroke.
• Tachycardia, a heart rate that is too fast.
• Wolf-Parkinson-White syndrome, a condition present at birth that leads to short circuits and rapid heartbeats in adulthood.
• Ventricular fibrillation, a severely abnormal heart rate that is life threatening. The most common cause of a heart attack.
Additionally, though not technically an arrhythmia, premature ventricular contractions start in the ventricles rather than the atria, causing an extra beat and fluttering feeling. These are normally not serious, but they can trigger a longer lasting arrhythmia.
When should you seek medical care?
Though not typically life-threatening, heart palpitations can often cause people to feel anxious and afraid. Don’t hesitate to call your doctor if you are concerned or if you are experiencing heart palpitations for the first time.
In addition, if you experience any of the following symptoms, contact your doctor right away:
• Your palpitations occur often (more than six per minute or in groups of three or more).
• Your pulse is higher than 100 beats per minute.
• You have risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
Call 911 or have someone take you to an emergency room if you have:
• Chest pain
• Shortness of breath
• Unusual sweating
• Dizziness or lightheadedness
How are heart palpitations diagnosed and treated?
After evaluating your symptoms, your doctor may perform tests to determine if your heart palpitations are caused by an arrhythmia or other condition. These tests may include:
• An electrocardiogram, which records the electrical activity of your heart.
• An echocardiogram, which uses sound waves to create a picture of your heart.
• A Holter monitor, which records your heart’s rhythm for 24 to 48 hours during your normal activity.
Treatment for arrhythmias vary depending on their type and severity and may include medication or certain procedures that restore the heart’s regular rhythm.
If your heart looks healthy, your doctor will likely recommend preventative measures to control palpitations, such as:
• Lowering your intake of caffeine and nicotine
• Reducing stress and anxiety
• Deep relaxation and breathing exercises
• Practicing yoga, mediation, or tai chi
• Getting regular exercise
• Not smoking
Though common, heart palpitations should not be ignored. If you experience an irregular heart rhythm, talk to your doctor so you can address the problem without missing another beat.
If you are having symptoms of a possible heart attack, stroke or another serious condition, do not hesitate to get the care you need. In accordance with guidelines from the Centers for Disease Control and Prevention and the New Jersey Department of Health, upon arrival every patient who comes to the Penn Medicine Princeton Health Emergency Department (ED) receives a mask, has their temperature taken, and is screened for COVID-19 symptoms. All of our ED rooms are private, and patients who are suspected of being infected do not share waiting areas or bathroom facilities with other patients.
Call 911 – do not let fear prevent you from seeking care.
To learn more about the safety measures established at Penn Medicine Princeton Health, review the safety video on our YouTube channel at https://youtu.be/MeAJJ_cKFVQ. To find a doctor with Princeton Health, call 888-742-7496 or visit www.princetonhcs.org. Many Princeton Health primary care physicians and specialists are seeing patients via telehealth or in person. It is best to contact your physician’s office if you have questions or concerns.
Sabahat Bokhari, M.D., is board certified in cardiovascular disease and is a member of the medical staff at Penn Medicine Princeton Health.