HEART PALPITATIONS | CAUSES, SYMPTOMS AND WHEN TO WORRY
Heart palpitations are the sensation of feeling your heartbeat in an unusual way, such as a racing, pounding, fluttering or irregular heartbeat.
Palpitations may occur at rest or during physical activity and may last for a few seconds, several minutes or longer. In many cases, palpitations are harmless, but they can sometimes be a sign of a heart rhythm disorder or another medical condition that requires evaluation.
WHAT ARE HEART PALPITATIONS?
Palpitations are not a disease by themselves. They are a symptom in which a person becomes unusually aware of their heartbeat.
A patient may feel that:
• The heart is beating very fast.
• The heart is beating strongly or forcefully.
• The heart is fluttering or vibrating in the chest.
• There is a skipped heartbeat or an extra heartbeat.
• The heartbeat feels irregular.
• The heart seems to pause briefly and then beat strongly.
CAUSES OF HEART PALPITATIONS
Palpitations can have many different causes. Some are temporary and harmless, while others may require medical evaluation.
Common causes include:
• Stress and anxiety.
• Panic or emotional distress.
• Lack of sleep and fatigue.
• Physical activity and exercise.
• Coffee, energy drinks and excessive caffeine.
• Smoking and nicotine.
• Dehydration.
• Fever or certain infections.
• Anemia.
• Thyroid disorders.
• Certain medications.
• Abnormal electrolyte levels.
• Heart rhythm disorders.
• Heart disease and coronary artery disease.
• Certain heart valve conditions.
HEART PALPITATIONS AND ANXIETY
Stress and anxiety are common causes of palpitations. During periods of stress, the body releases hormones such as adrenaline, which can increase the heart rate and make the heartbeat feel stronger.
However, not every episode of palpitations should automatically be attributed to anxiety, particularly when symptoms are recurrent, unexplained or associated with dizziness, shortness of breath or chest pain.
HEART PALPITATIONS AFTER COFFEE AND STIMULANTS
Caffeine and other stimulants may increase the awareness of the heartbeat in some people.
Palpitations may occur after consuming:
• Coffee.
• Energy drinks.
• Large amounts of tea.
• Certain supplements or products containing stimulants.
If a specific substance appears to trigger symptoms, reducing or avoiding it and monitoring the symptoms may be helpful.
HEART PALPITATIONS AT REST
Some people experience palpitations while sitting, relaxing or lying down, even without physical activity.
The cause may be something relatively simple, such as stress, caffeine or lack of sleep, but palpitations at rest can also be associated with a heart rhythm disorder.
Recurrent, severe or unexplained palpitations at rest may require an ECG, Holter monitoring or further cardiac evaluation.
HEART PALPITATIONS BEFORE SLEEP OR DURING THE NIGHT
Some people become more aware of their heartbeat when lying down or preparing to sleep because there are fewer distractions and the environment is quiet.
Night-time palpitations may be related to stress, stimulants, lack of sleep or certain heart rhythm disorders.
If palpitations repeatedly occur before sleep, wake the patient from sleep or are associated with dizziness, shortness of breath or chest pain, medical evaluation is recommended.
ARE HEART PALPITATIONS DANGEROUS?
In many cases, palpitations are not dangerous. However, their significance depends on the underlying cause and any associated symptoms.
Palpitations should be medically evaluated when they:
• Occur frequently or become more severe over time.
• Occur without an obvious trigger.
• Are associated with dizziness or near-fainting.
• Are associated with shortness of breath.
• Are associated with chest pain or pressure.
• Are associated with fainting.
• Occur with a very rapid or clearly irregular heartbeat.
• Occur in a patient with known heart disease.
HEART PALPITATIONS AND HEART RHYTHM DISORDERS
Palpitations may be caused by a heart rhythm disorder, including:
• Atrial fibrillation.
• Supraventricular tachycardia (SVT).
• Tachycardia.
• Bradycardia or conduction disorders.
• Premature heartbeats.
• Certain ventricular arrhythmias.
Recording the heart rhythm during symptoms can be particularly important for establishing the correct diagnosis.
HOW IS THE CAUSE OF PALPITATIONS DIAGNOSED?
Evaluation begins with a detailed assessment of the symptoms, including when they occur, how long they last, possible triggers and associated symptoms.
Depending on the clinical situation, investigations may include:
• Electrocardiogram (ECG).
• 24-hour or longer Holter monitoring.
• Extended cardiac rhythm monitoring when necessary.
• Echocardiography (Echo).
• Blood tests.
• Thyroid function testing.
• Electrolyte testing when appropriate.
• Exercise stress testing in selected patients.
• Additional cardiac rhythm investigations when required.
THE ROLE OF HOLTER MONITORING IN PALPITATIONS
One of the challenges in diagnosing palpitations is that symptoms may be intermittent and may not occur during a medical visit.
A standard ECG may be completely normal between episodes. Holter monitoring can therefore be very useful in selected patients.
Holter monitoring continuously records the heart's electrical activity during normal daily activities and can help:
• Detect abnormal heart rhythms.
• Determine the heart rate during symptoms.
• Identify the duration of an episode.
• Establish whether symptoms are associated with a true rhythm abnormality.
• Correlate the patient's symptoms with the recorded heart rhythm.
WHEN IS HOLTER MONITORING RECOMMENDED?
Holter monitoring may be recommended when palpitations are recurrent, intermittent or unexplained and are not captured on a standard ECG.
It can be particularly useful when palpitations are associated with dizziness, near-fainting, fainting, shortness of breath or a clearly irregular pulse.
HEART PALPITATIONS AND ATRIAL FIBRILLATION
Atrial fibrillation is one of the heart rhythm disorders that can cause palpitations and an irregular heartbeat.
Episodes of atrial fibrillation may be intermittent and may not be present when a standard ECG is performed.
Holter monitoring or longer-term cardiac rhythm monitoring may help detect these episodes in appropriately selected patients.
HEART PALPITATIONS AND RAPID HEARTBEAT
Palpitations may be caused by a rapid heart rate, but feeling your heartbeat does not necessarily mean that the heart rate is always elevated.
Recording the heart rhythm during symptoms can help determine whether the patient has tachycardia, another rhythm disorder or simply increased awareness of normal heartbeats.
TREATMENT OF HEART PALPITATIONS
There is no single treatment for all cases of palpitations because treatment depends on the underlying cause.
Management may include:
• Treating the underlying medical condition.
• Reducing or avoiding stimulants that trigger symptoms.
• Improving sleep and managing stress.
• Treating anemia or thyroid disorders when present.
• Correcting dehydration or electrolyte abnormalities when appropriate.
• Medications to control heart rate or rhythm when needed.
• Specific medications depending on the type of rhythm disorder.
• Catheter ablation for selected heart rhythm disorders.
• Other specialized treatments when appropriate.
WHEN ARE PALPITATIONS AN EMERGENCY?
Immediate medical attention should be sought when severe or persistent palpitations are associated with:
• Severe chest pain or pressure.
• Significant shortness of breath.
• Fainting or loss of consciousness.
• Severe dizziness.
• Sudden severe weakness or deterioration.
• Sudden neurological symptoms such as weakness of one side of the body or difficulty speaking.
SPECIALIZED EVALUATION OF HEART PALPITATIONS
Palpitations are common and can have many different causes. Identifying the underlying cause is essential for selecting the appropriate treatment.
Each patient is assessed individually based on the nature, timing and duration of the palpitations, associated symptoms, medical history and the results of ECG, Holter monitoring, echocardiography and other investigations when appropriate.
If you experience recurrent or unexplained heart palpitations, ECG or Holter monitoring may help identify the cause of your symptoms and determine whether a heart rhythm disorder is present.
Dr. Ghassan Shawabkeh provides specialized evaluation for patients experiencing heart palpitations and suspected heart rhythm disorders, with appropriate diagnostic testing and an individualized follow-up or treatment plan based on each patient's condition.