Palpitations

What does it mean if your heart feels as if it’s beating too fast, fluttering or skipping a beat?

Maybe you’re in love. It can happen. When you see your true love, an adrenaline rush causes the heart to beat faster and stronger. Or, caffeine lover, you’ve had too much coffee. (Yes, caffeine can affect the heart that much.) These palpitations usually aren’t serious and are often as fleeting as love or an 8-ounce Blonde Roast – they disappear quickly.

Most people have experienced palpitations, unrelated to any underlying heart problem. But it’s important to know that not all palpitations are harmless. Some are a sign of an abnormal heart rhythm (arrhythmia) or more serious heart problems that require medical attention.

Symptoms

Naturally, it’s a bit scary whenever you sense your heart beating irregularly. The most obvious place you’ll feel it is in the chest area, but also in the throat or neck.

They can happen at any time, whether you’re jogging through the park or sprawled on the couch. Whenever they happen, it feels as if the heart:

  • Skips beats.
  • Beats too hard.
  • Beats too fast.
  • Flutters.
  • Pumps harder than usual.

If you’re experiencing heart palpitations for the first time, see your primary care physician.

Call you doctor immediately if you:

  • Have high cholesterol, high blood pressure, diabetes or other risk factor for heart disease.
  • Feel extra heartbeats.
  • Experience palpitations different than in the past.
  • Measure your pulse at more than 100 beats per minute, assuming you’re not exercising, have a fever or are suffering from anxiety.

Call 9-1-1 or visit a local emergency department if you experience:

  • Chest pain.
  • Dizziness.
  • Lightheadedness.
  • Shortness of breath.
  • Unusual sweating.

Causes

Sometimes the cause of palpitations has nothing to do with the heart:

  • Nicotine use.
  • Caffeine use.
  • Alcohol use.
  • Diet pills.
  • Cocaine or other illicit drugs.
  • Fever.
  • Exercise.
  • Anxiety, stress, fear, panic attacks or other strong emotion.
  • Certain herbal and nutritional supplements.
  • Eating foods with MSG (monosodium glutamate), sodium or nitrates.

When they’re caused by an abnormal heart rhythm:

  • Heart disease.
  • Overactive thyroid.
  • Abnormal heart valve (mitral valve prolapse)
  • Insufficient oxygen in the blood.
  • Abnormal potassium levels in the blood.

Treatment

Diagnosing palpitations isn’t easy because they don’t last long and it might be difficult to replicate in your doctor’s office or emergency department.

Your doctor will ask about symptoms (shortness of breath, chest pain and sweating) more likely caused by a heart problem. Your medical history, including whether you have heart or lung disease, and a description of the palpitations are also important elements of the diagnosis.

A physical exam, blood tests and an electrocardiogram (EKG) that assesses your heart’s electrical activity will help determine if the palpitations were, in fact, caused by an arrhythmia and the appropriate treatment.

Types of Arrhythmia

Bradyarrhythmia: An adult’s heart rate slower than 60 beats per minute qualifies as a bradyarrhythmia, or bradycardia. (In some cases, a slow heart rate is considered normal.) A disease in the heart’s conduction system – muscle cells in the heart’s walls that send signals to the heart muscle that cause it to contract – also might be the cause.

Tachycardia: A faster-than-normal heart rate. (Anything more than 100 beats per minute.)

Ventricular: Arrhythmias that begin in the heart’s lower chambers, the ventricles.

Supraventricular: Arrhythmias that begin in the heart’s upper chambers, the atria. Some examples:

  • Atrial fibrillation: The upper chambers of the heart contract abnormally because of an irregular heart rhythm. Very common.
  • Paroxysmal supraventricular tachycardia: A rapid heart rate, with a regular heartbeat, that starts and ends suddenly.
  • Atrial Flutter: A misfiring in the right atrium that causes the atria to beat at close to 300 beats per minute as the ventricles, the heart’s lower chamber,  slow to anywhere from 75 to 150 beats per minute. People with heart disease, the elderly and patients in the first week following heart surgery are susceptible. Atrial flutter can evolve into atrial fibrillation.
  • Accessory pathway tachycardias: A rapid heart rate caused by an abnormal electrical pathway between the atria and ventricles.
  • Premature atrial contractions: Early extra beats, usually harmless. This is the most common type of arrhythmia: Researchers found that 99 percent of people age 50 or older in one study had at least one premature atrial contraction when monitored for 24 hours.