Heart Palpitations: What’s Normal and When to Worry

Your heart is designed to beat in a regular rhythm (sinus rhythm) somewhere between 60-100 times per minute.

But sometimes the heart can have irregular rhythms or heartbeats.

Heart palpitations are when it feels like your heart is skipping beats or fluttering for short periods of time.

It also can feel like pounding or flip-flopping. 

Palpitations can be a symptom of another condition—like anxiety, stress, use of stimulants or medications, or an underlying health condition—or it can be a condition in and of itself.

Read on to learn why it may feel like your heart is fluttering and how your medical provider will diagnose what is going on.

Also, learn what treatments are available and when it’s time to contact your medical provider about your heart palpitations.

What Are Heart Palpitations?

Palpitations are abnormally rapid pulses or irregular heartbeats.

They can be felt in the chest or neck and are described as:

• Skipped beats
• Pounding sensations
• Flip-flopping in the chest

Heart palpitations are one of the most common reasons for people to visit the emergency room.

Causes

Feeling a few skipped beats here and there can be normal for some people, and most of the time, the reason for the palpitations is not serious.

But in some cases, it means there is something more serious going on. 

Read on to learn what may be causing your heart palpitations.

Anxiety or stress

Having stress is your body’s way of reacting to a demanding situation or challenge.

Some levels of stress can be positive, but too much stress can have a negative impact on your health. 

During times of anxiety or stress, your body releases hormones to make you more alert, make your muscles tenser, and make your heart beat faster.

Sometimes, too many of these hormones can also make you have heart palpitations.

Exercise

While exercising, you are putting physical stress on your body.

Similar to psychological stress, your body also releases hormones to meet the demands you are putting on it during exercise.

These hormones come from your adrenal glands and help speed up your heart rate, and they can also cause palpitations. 

Stimulants

Stimulants are medications or substances that speed up the body’s systems.

Caffeine, for example, is a type of stimulant.

Examples of prescription drugs that are stimulants include:

• Amphetamines (Adderall^Ⓡ)
• Methylphenidate (Ritalin^Ⓡ)
• Diet aids (Didrex^Ⓡ, Bontril^Ⓡ, Fastin^Ⓡ)

When used as prescribed (or in moderation in the case of caffeine), stimulants can help you feel more awake or alert and can decrease your appetite.

However, taking too large of a dose may cause side effects, such as:

• Dizziness 
• Tremors
• Flushed skin
• Headache
• Chest pain
• Heart palpitations
• Sweating
• Stomach pain and vomiting

Hormonal changes

Menopause is a major shift of hormones that usually starts around 51 years of age.

The body’s estrogen levels decrease, which can have an effect on many parts of the body, including the heart.

Symptoms of menopause usually last for about seven years and can include:

• Hot flashes
• Fatigue
• Heart palpitations
• Poor concentration
• Low moods
• Vaginal dryness
• Anxiety
• Urinary incontinence

Electrolyte imbalances

Electrolytes are electrically charged minerals that play a large role in your body, including balancing fluids and controlling nerve activity, muscle activity, and heart rhythm. 

When your electrolytes are imbalanced, it can cause serious medical conditions, such as kidney issues and heart problems like palpitations and arrhythmias. 

Electrolytes can become imbalanced with dehydration, nausea, vomiting, diarrhea, kidney disease, heart disease, and diabetes. 

Anemia

Anemia is when the body doesn’t have enough red blood cells.

Red blood cells are important to your body because they provide oxygen to all your organs and tissues. There are different types of anemia that have different causes, including loss of blood (e.g., injury), vitamin B12 deficiency, and iron deficiency. 

Symptoms of anemia can include:

• Paleness
• Fatigue
• Feeling lightheaded
• Headaches
• Irritability
• Changes in heart rhythm

Thyroid problems

Your thyroid is a butterfly-shaped gland in your neck that produces thyroxine and triiodothyronine.

Together, these thyroid hormones have significant effects on the functions of the body and heart, including:

• Cardiac output
• Heart contractions
• Blood pressure
• Heart rhythm

Hyperthyroidism is when you have an overactive thyroid.

Hypothyroidism is when your thyroid is not producing enough hormone.

Both hypothyroidism and hyperthyroidism can cause you to experience cardiac symptoms, including palpitations.

Certain medications

Some medications prescribed by your medical provider can cause arrhythmias.

If you start to experience heart palpitations while you are taking medications, let your medical provider know. 

Some common medications that can cause palpitations are:

• Blood pressure medications
• Certain antibiotics
• Over-the-counter (OTC) allergy and cold medications

Risk Factors

Risk factors for heart palpitations include:

• Stressful situation or event
• High levels of anxiety
• Caffeine intake
• Taking stimulant medications or illegal drugs
• Low levels of electrolytes
• Dehydration
• Physical activity
• Hyperthyroidism or hypothyroidism
• Blood pressure medications
• Certain antibiotics
• OTC allergy and cold medications

Diagnosis

To diagnose what is going on with your heart, your medical provider will want to start with a full review of your medical history and the current medications you are taking.

Then they will perform a physical assessment.

During the exam, they may ask you some of the following key questions:

• At what age did the palpitations begin?
• What do the palpitations feel like?
• How long do the palpitations last?
• What situations have triggered the events?
• Does anything help stop the palpitations?
• Do you have any other symptoms, like lightheadedness, during the episodes?

Blood tests

An initial blood test should include checking for:

• Anemia
• Infection
• Electrolyte imbalances
• Kidney dysfunction
• Thyroid dysfunction

Urine tests

A urine test can check for urinary tract infection, kidney problems, and diabetes.

For the test, you will be asked to give a sample of urine in a sterile cup, which is then sent to a lab for testing. 

Electrocardiogram (EKG)

An electrocardiogram (EKG) is essential for correct diagnosis.

This test records the electrical activity of your heart and is completed by attaching electrodes to several places on your chest, arms, and legs while you are lying down.

The medical technician will ask you to lie very still and maybe even hold your breath while they record.

There are some types of EKGs that are mobile for longer use.

Sometimes you may be asked to wear one of the recording devices for 24 hours or more.

The goal is to catch your heart having palpitations so the medical team can assess what is going on. 

Stress test

A stress test measures how your heart handles physical activity.

To perform a stress test, electrical nodes are placed on your chest, arms, and legs.

The nodes are attached to an EKG machine, which records the electrical activity of your heart. 

You will then start walking on a treadmill or pedaling a stationary bike.

At first, the resistance is low and the pace is slow.

Over time, the medical technician will increase the speed and resistance to see how your heart does.

This continues until you’ve reached the goal set by your provider. 

The test is stopped if you experience any cardiac symptoms or if the EKG records any heart activity that is unsafe. 

Echocardiogram

An echocardiogram is an ultrasound of the heart.

The test uses sound waves to see the inside of the heart without exposing you to radiation.

For the test, you lie still on a bed while a technician slowly moves an ultrasound probe over the area of your heart while taking images of the internal structures.

Treatment

In many cases, palpitations are not serious and don’t require treatment.

If the palpitations are frequent, your medical provider may prescribe some medication to help keep your heart rate lower.

In more severe cases, a procedure called ablation is sometimes performed to help stop frequent palpitations from occurring. 

Prevention

To avoid having palpitations:

• Avoid palpitation triggers
• Treat medical conditions that cause triggers
• Eat a balanced diet
• Get regular exercise
• Maintain a healthy weight
• Stop smoking
• Manage your stress level
• Avoid energy drinks and limit caffeine

When to See a Medical Professional

If you are experiencing palpitations for the first time, see your medical professional. 

Call 911 if you are experiencing palpitations along with the following symptoms:

• Fainting
• Feeling dizzy or lightheaded
• Chest pain
• Short of breath
• Clammy or sweaty

Call your medical professional if you are experiencing palpitations along with any of the following symptoms:

• You have a high-risk medical condition, such as heart disease, diabetes, high blood pressure, or high cholesterol
• You feel different or new palpitations
• Your heart is beating faster than 100 beats per minute while resting

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