When to worry about heart palpitations

Have you ever woken up feeling like your heart is going to pound out of your chest? Heart palpitations are often harmless, but they can also be a sign of something more serious. Here’s a guide to help you understand when to worry about heart palpitations and when to speak to your doctor.

What are heart palpitations?

Heart palpitations are very common and are often described as the feeling that your heart is pounding, racing or skipping beats. The palpitations can be irregular and may not always be associated with a fast heart rate.

You might feel heart palpitations in your chest, throat or neck. They can happen when you're active, resting or even lying down.

What causes heart palpitations?

Heart palpitations can occur for a wide variety of reasons. Here are some of the most common causes of heart palpitations:

• Emotional stress or anxiety
• Stimulants like caffeine, alcohol and nicotine
• Vigorous physical activity
• Hormonal fluctuations during pregnancy or menopause
• An overactive thyroid
• Medications, including over-the-counter cold medicines
• Underlying heart conditions

Heart conditions that cause palpitations

Although they’re usually harmless, sometimes, heart palpitations can be a symptom of an underlying heart condition.

Primary arrhythmias

Five different types of arrhythmias, or abnormal heart rhythms, can cause palpitations.

• Atrial fibrillation: This irregular and often rapid heart rhythm occurs when the heart's upper chambers (atria) beat out of sync with the lower chambers (ventricles). AFib can lead to poor blood flow and increase the risk of stroke and other heart complications. Symptoms often include palpitations, shortness of breath and fatigue.
• Premature atrial contractions (PACs): These are skipped beats from the top (atrial) chambers. These are almost always benign, which means it’s not harmful.
• Premature ventricular contractions (PVCs): These are skipped beats from the bottom (ventricular) chambers. These are typically benign but can also cause a weakening of the heart muscle if they are very frequent. PVCs can also be a concern if you also have heart failure (weak ventricle) or have experienced a prior heart attack.
• Supraventricular tachycardia: This is a benign rapid rhythm from the top chambers (atria) of the heart.
• Ventricular tachycardia: This is a potentially life-threatening rhythm from the bottom chamber (ventricle) of the heart. It is usually seen in people with heart failure or who have had a previous heart attack.

Structural heart disease

If you have a weak right or left ventricle, a history of heart attack or a heart valve condition such as mitral valve prolapse (a floppy valve on the left side of the heart), it’s important to take your symptoms of palpitations seriously. Talk to your doctor about palpitations or any other new or concerning heart symptoms.

Anxiety and heart palpitations

Anxiety can force your body to release stress hormones, which can increase your heart rate and cause heart palpitations or flutters. This is especially common during panic attacks or times when you are under intense stress.

If the palpitations are anxiety-related, you might have other symptoms such as sweating, trembling, shortness of breath or a feeling of dread or doom. Often, anxiety-related palpitations are short-lived and go away when the anxiety lessens.

Heart palpitations from caffeine

One common trigger for heart palpitations is caffeine, a stimulant found in coffee, tea, energy drinks and certain medications. Caffeine stimulates the central nervous system, increasing heart rate and blood pressure.

It blocks adenosine, a neurotransmitter that promotes relaxation and sleep, leading to increased adrenaline release. This surge in adrenaline can cause the heart to beat faster and harder, resulting in palpitations.

Not everyone experiences this effect from caffeine. How you feel is influenced by your individual sensitivity to caffeine, any underlying heart conditions, anxiety and the amount of caffeine you have.

Heart palpitations from alcohol

Alcohol can also cause heart palpitation because it affects the cardiovascular system in several different ways. While it acts as a depressant, alcohol can also stimulate your heart by interfering with the autonomic nervous system, which controls involuntary bodily functions, including heart rate.

This interference can cause the heart to beat irregularly, leading to palpitations. Some factors that increase the risk of these types of heart palpitations include:

• Binge drinking
• Chronic alcohol use
• Dehydration
• Electrolyte imbalance
• Underlying heart conditions

Hormonal changes and heart palpitations

Hormones play a crucial role in regulating many body functions, including heart rate and rhythm. Variations in hormone levels can impact the autonomic nervous system, which controls your heart rate. This disruption can lead to palpitations. Common hormonal triggers are:

• Menopause
• Your menstrual cycle
• Pregnancy
• Thyroid disorders

Medications that cause heart palpitations

Some medications can stimulate the heart or disrupt the normal electrical signals that regulate heart rhythm. This can result in palpitations, where the heart beats faster, slower or more irregularly than usual.

Common medications linked to heart palpitations are stimulants:

• ADHD medications
• Antidepressants
• Asthma inhalers
• Blood pressure medications
• Decongestants
• Thyroid medications

Heart palpitations at night

Experiencing heart palpitations at night can be unsettling, especially when they disrupt your sleep. Several factors can cause these palpitations including:

• Anxiety and stress
• Certain medications
• Drinking caffeine and alcohol
• Hormonal fluctuations
• Sleep apnea

When to see a doctor for heart palpitations

Most of the time, heart palpitations aren’t dangerous. If they’re occasional and go away on their own, there’s usually no need for concern. Staying hydrated, reducing caffeine intake and managing stress can help reduce your palpitations.

While many heart palpitations are nonthreatening, some can indicate more serious conditions, such as arrhythmias or other heart issues. You should contact your primary care physician or cardiologist if you have:

• Frequent or persistent heart palpitations
• Heart palpitations accompanied by chest pain, shortness of breath, fainting or severe dizziness
• A history of heart disease or other risk factors
• Heart symptoms that are interfering with daily activities or causing significant distress

If you experience any of the concerning symptoms listed above, your physician may want to find out more with some diagnostic tests. They may order an electrocardiogram to measure the electrical activity of your heart, conduct an echocardiogram which uses ultrasound to visualize your heart structure and function, or prescribe you a Holter Monitor to record your heart’s electrical activity.

Heart palpitations can be alarming, but they’re usually not dangerous. However, if you notice accompanying symptoms like dizziness or chest pain—or you’re worried about your heart health for any reason—schedule an appointment with your doctor.

Find a cardiologist near you.