Experiencing heart palpitations—the feeling that your heart is racing, pounding, or skipping a beat—is common, especially as individuals get older. In the vast majority of people, the cause is benign. That said, heart palpitations can sometimes be a sign of a serious—or even potentially life-threatening—heart problem, so it’s important to see your physician if you’re having them.
They are also a common symptom of anxiety. If the cause of your palpitations does turn out to be anxiety, there are steps you can take to prevent these disturbances, or at least limit them when they do occur.
Finding the cause
Although usually described as a racing or pounding heart, the sensation of palpitations isn’t the same for everybody. In one person the heart may race for a few seconds, while in another an extra heartbeat or two causes a “flipflop” feeling in the chest or neck. Being able to accurately describe your heart palpitations—and any other symptoms you’re experiencing—can help your doctor determine why you’re having them.
Palpitations have a variety of causes, including:
Heart-related. An arrhythmia (abnormal heart rhythm) is a common heart-related cause of palpitations.
Arrhythmias are known by various names based on the part of the heart affected or the type of abnormal heartbeat. Arrhythmias that can cause palpitations include atrial fibrillation, ventricular tachycardia, bradycardia, and long QT syndrome. Some arrhythmias are relatively harmless and do not need to be treated, but others can be life-threatening and require thorough evaluation and treatment.
Structural problems of the heart can cause arrhythmias. These include coronary artery disease, valvular heart problems, cardiomyopathy (diseases of the heart muscle), congenital heart disease, and congestive heart failure (when the heart is unable to pump enough blood to meet the body’s needs). The risk of having a heart-related cause of palpitations is higher for individuals who have a history of heart disease.
Psychiatric. After heart problems, anxiety is the most common cause of palpitations. A 2017 study published in the journal Psychiatry and Clinical Psychopharmacology found that people who had heart palpitations that were not caused by a heart problem scored significantly higher on a scale used for measuring anxiety than people who did not have palpitations.
For people who have both anxiety and heart palpitations, it may be difficult to determine whether they experience palpitations because they start to feel anxious, or vice versa. Panic attacks can also cause palpitations. About a third of people who experience heart palpitations also have panic attacks.
Other causes. Many medications can cause heart palpitations, particularly stimulants, including amphetamines and certain illicit drugs such as cocaine, and some drugs used to treat asthma, high blood pressure, heart failure, or stomach problems.
Consuming too much caffeine, alcohol, or nicotine can also be to blame. Medical conditions that can cause heart palpitations include thyroid disease, low blood sugar, and low levels of oxygen or electrolytes (sodium and potassium) in the blood. In about 1 in 7 people, however, no cause of palpitations can be found.
When to seek treatment
If you are experiencing heart palpitations and have never had them before, you should seek prompt medical attention. Don’t assume that they’re caused by anxiety or that they aren’t serious.
Even if you have already been diagnosed with an anxiety disorder or panic attacks, it is still possible that there’s a heart-related cause of your palpitations. Your doctor will need to rule that out.
Call 911 or immediately go to the nearest emergency room if you have fainted or have chest pain, shortness of breath, or dizziness at the same time as heart palpitations. If you’ve had heart palpitations before, contact your doctor if you notice a sudden change in your palpitations—for example, if they occur more frequently than in the past.
Take notes describing your palpitations, including what they feel like, when they occur, and how often they occur. In addition to helping your doctor determine the cause, this information might help you identify anything that may be triggering your palpitations, such as caffeine or a specific medication, so you can avoid it.
What to expect
Your doctor will ask about your symptoms and complete medical history and then examine you. Be sure to bring to your appointment a list of all of the medications you take, including over-the-counter drugs and any vitamins, supplements, or herbal remedies.
Your doctor may ask you to tap out with your fingers the specific abnormal heart rhythm you feel. He or she will perform an electrocardiogram (ECG) to measure your heart’s rhythm. The results of the ECG will help determine what happens next. If the ECG shows an arrhythmia, your doctor may order other tests, refer you to a cardiologist, or start treatment based on the specific type of arrhythmia.
For most people with heart palpitations, an ECG will be normal. In such an instance, your doctor may order additional testing. Ambulatory ECG monitoring provides a view of your heart’s rhythm over an extended period of time and has the ability to detect problems that an ECG may miss. Other cardiac tests might include an echocardiogram (a sonogram of your heart), an electrophysiology study (to evaluate your heart’s electrical activity), or a coronary angiogram (a special X-ray to see if your arteries are blocked or narrowed). Laboratory blood tests might be ordered to rule out anemia or hyperthyroidism.
If testing indicates that there is no heart-related cause of your palpitations, your doctor will consider other potential causes, including anxiety. He or she will use specific criteria to determine if you have an anxiety or panic disorder. Describing and keeping track of what you are doing and how you are feeling immediately before you have palpitations can help determine whether your palpitations and anxiety are linked.
If your doctor rules out heart-related or other causes of your palpitations, no specific treatment may be necessary. He or she may recommend that you seek treatment for your anxiety or panic attacks if you haven’t already done so, or that you see your psychiatrist or psychotherapist for a possible adjustment to treatment you may already be receiving.
There are steps you can take to avoid having palpitations or to make them less intense when they do occur:
- Consume less caffeine or alcohol, because these substances can trigger palpitations.
- If you smoke or use any other form of nicotine—another stimulant—ask your doctor for help quitting.
- As long as your doctor says it is OK to do so, exercise regularly, as this can help lower stress.
Meditation, tai chi, yoga, deep breathing exercises, and other relaxation techniques can help lower stress, as well. Note that stress is a common cause of palpitations.
The most important thing to remember is to have heart palpitations promptly evaluated the first time they occur in order to rule out a potentially serious health condition. Even palpitations caused by a heart problem may not be serious, and those that are can usually be treated successfully. Learning to manage your anxiety and stress levels can help to reduce or eliminate your heart palpitations.
This article first appeared in the UC Berkeley 2019 Depression and Anxiety White Paper.
Also see Workplace Stress and Atrial Fibrillation.