Considerations

Normally the heart beats 60 - 100 times per minute. In people who exercise routinely or take medications that slow the heart, the rate may drop below 55 beats per minute.

If your heart rate is fast (over 100 beats per minute), this is called tachycardia. A slow heart rate is called bradycardia. An occasional extra heartbeat is known as extrasystole.

Palpitations are usually not serious. However, it depends on whether or not the sensations represent an abnormal heart rhythm ( arrhythmia). The following conditions make you more likely to have an abnormal heart rhythm:

• Known heart disease at the time the palpitations begin
• Significant risk factors for heart disease
• An abnormal heart valve
• An electrolyte abnormality in your blood -- for example, a low potassium level

Causes

 Heart palpitations are most often not serious. They can be due to:

• Anxiety, stress, panic attacks, or fear
• Caffeine and nicotine use
• Cocaine or other illegal drugs
• Diet pills
• Exercise
• Fever

However, some palpitations are due to an abnormal heart rhythm, which may be caused by:

• Heart disease
• Abnormal heart valve, such as mitral valve prolapse
• Abnormal blood levels of potassium
• Certain medications, including those used to treat asthma, high blood pressure, or heart problems
• Overactive thyroid
• Low levels of oxygen in your blood

Home Care

• Reduce your caffeine and nicotine intake. This will often reduce heart palpitations.
• Learn to reduce stress and anxiety. This can help prevent palpitations and help you better manage them when they occur.
• Try breathing exercises or deep relaxation (a step-by-step process of tensing and then relaxing every muscle group in your body)
• Practice yoga, meditation, or tai chi.
• Get regular exercise. 
• Do not smoke.

Once a serious cause has been ruled out by your doctor, try not to pay close attention to heart palpitations. This may cause stress. However, contact your doctor if you notice a sudden increase or a change in them. 

When to Contact a Medical Professional

If you have never had heart palpitations before, see your health care provider.

The following symptoms require immediate attention. Call 911 or your local emergency number:

• Lose of alertness (consciousness)
• Chest pain
• Shortness of breath
• Unusual sweating,
• Dizziness lightheadedness

Call your doctor right away if:

• You feel frequent extra heartbeats (more than 6 per minute or coming in groups of 3 or more).
• You have risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
• You have new or different heart palpitations.
• Your pulse is more than 100 beats per minute (without exercise, anxiety, or fever).

What to Expect at Your Office Visit

Your doctor or nurse will examine you and ask questions about your medical history and symptoms.

You may be asked:

• Do you feel skipped or stopped beats?
• Does your heart rate feel slow or fast when you have the palpitations?
• Do you feel a racing, pounding, or fluttering?
• Is there a regular or irregular pattern to the unusual heartbeat sensations?
• Did the palpitations begin or end suddenly?
• When do the palpitations occur? In response to reminders of a traumatic event? When you are lying down and resting? When you change your body position? When you feel emotional?
• Do you have any other symptoms?

 An electrocardiogram will be done.

In the emergency room, you will be connected to a heart monitor.

If your doctor finds you have an abnormal heart rhythm, other tests may be done. This may include:

• Holter monitor for 24 hours, or another heart monitor for two weeks or longer
• Echocardiogram
• Electrophysiology study (EPS)
• Coronary angiography

Prevention

What can I do to prevent palpitations?

To help lessen heart palpitations:

·        Decrease your stress level (Learn biofeedback, deep breathing and/or relaxation exercises such as yoga, tai chi, or guided imagery)

·        Limit alcohol

·        Limit caffeinated beverages

·        Do not smoke or use tobacco products

·        Exercise on a regular basis (Ask your doctor what exercise program is right for you)

·        Avoid certain activities that appear to be associated with palpitations

·   

Alternative Names

Heartbeat sensations; Irregular heartbeat; Palpitations; Heart pounding or racing

References

Goldman L. Approach to the patient with possible cardiovascular disease. In Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 48.