What are heart palpitations? 

Heart palpitations are heartbeat sensations that you suddenly become aware of because they feel like  your heart is “pounding” or “racing.” They may feel like you have exercised or they may feel like a flutter, a skipped or extra  beat, or a heartbeat that simply does not feel normal. Palpitations can occur at any time -- while you are simply sitting  or moving about normally as you perform your daily activities. 

Palpitations can be felt  in your chest, throat or neck. Although heart palpitations may be startling, they may  or may not be related to an abnormal heart rate and are often not serious or harmful.
What causes heart palpitations? 

Heart palpitations may be caused by: 

• Emotions, such as anxiety, stress, fear, panic 
• Exercise 
• Pregnancy 
• Caffeine found in coffee, teas, chocolate, colas, some sports drinks  and foods 
• Certain medical conditions: overactive thyroid, low blood sugar, low potassium level, low oxygen level or low carbon dioxide level in the blood, fever, anemia, dehydration, loss of blood, shock 
• Certain medications: asthma inhalers and decongestants, beta blockers (taken for high blood pressure or heart disease), thyroid and antiarrhythmic medications, and some over-the-counter medications that act as stimulants,  such as cough and cold medicines, and some herbal  or nutritional supplements 
• Illegal street drugs: cocaine and amphetamines (speed) 
• Nicotine found in tobacco products 
• Alcohol

• Significant risk factors for heart disease 
• Existing heart disease 
• Heart rhythm problems – also called irregular heartbeats  or arrhythmias (a change in rhythm of your heartbeat) 
• Abnormal  heart valve 

• Dizzy 
• Confused 
• Light-headed 
• Have trouble breathing 
• Pass out while experiencing  the palpitations

If you experience these symptoms, call your doctor’s office right away. Also call your doctor’s office if the  palpitations are accompanied by pain, pressure, or tightness in your chest, neck, jaw, arms, or upper back; shortness  of breath; unusual sweating; or if you experience new or worsening symptoms. 

How  are palpitations diagnosed? 

It may be difficult for your doctor to determine  the cause  of your palpitations, especially if you  are not experiencing them during your office visit. In some cases, a cause  of the palpitations may not be found. Despite these obstacles, your doctor will review your medical history, ask you about your symptoms, review any medications and herbal products you may be taking, and ask you about your diet. Your doctor will also listen to your  heart and lungs. 

Your doctor may order certain tests or refer you to a cardiologist who may order additional tests such as: blood and urine tests, electrocardiogram (EKG), stress test, chest x-ray, echocardiogram (heart ultrasound), and a heartbeat monitoring test called an ambulatory cardiac monitor. If a  heart problem is suspected, more invasive tests, such as an electrophysiology study or cardiac catheterization may be performed. 

How are palpitations treated? 

Treatment depends on what is causing the palpitations. Your doctor will use the results of the diagnostic tests to determine if you have any underlying  heart disease causing the symptoms. He  or she will also see if the symptom is actually related to an abnormal  heart rhythm. In most cases, if you are otherwise healthy, no treatment will be necessary. If you notice palpitations occur with certain activities or food, you should avoid those activities. 

If  the heart  palpitations bother you and you  have other health problems, your doctor will determine an appropriate treatment plan that may include medications or more invasive procedures, surgery or implantation of an electrical to restore a normal heart rhythm, or correct an underlying heart problem 

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
• Avoid certain medications  that act  as stimulants, such as cough  and cold medicines,  and some herbal or nutritional supplements 
• Make sure your blood pressure and cholesterol are well controlled 
• Try not to pay attention to your heart palpitations once any serious causes have been ruled out. 

To help your doctor diagnose your condition, keep track of your heart palpitations. Note when they happen, how long they last, how you are feeling when they occur, and if you are doing an activity when they occur. Share this information with your doctor. If you notice a sudden increase in the palpitations or any type of change in them, call your doctor. Keep all scheduled follow-up visits with your doctor so your condition can be monitored. 

How to find a doctor if you have palpitations 

Sometimes you may begin your evaluation with your family doctor or internist, and may be referred to a cardiologist for a more complete evaluation and diagnostic studies.  You may require additional specialists who diagnose and treat severe heart rhythm abnormalities.  These specialists are known as cardiac electrophysiologists.