Irregular Heartbeat - Palpitations

Overview, Causes, & Risk Factors

The term palpitations describes an unusual awareness of the heartbeat.

What is going on in the body?

Ordinarily, a person is not aware of the beating of his or her heart. Under certain circumstances, such as when scared or under stress, a person may become aware of the heartbeat. This awareness of the heartbeat is known as palpitations. Often, the heart may seem to beat faster or harder than usual. In some cases, palpitations may occur due to an irregular heartbeat, also called an arrhythmia.

Palpitations happen to almost everyone at some time in their life. Usually they're nothing to worry about. In some people, the perception of having palpitations is caused by emotion or stress rather than an actual extra beat. However, palpitations may signal a serious condition, especially if they are caused by an arrhythmia.

What are the causes and risks of the condition?

Common causes of palpitations include:

  • anxiety
  • fever
  • medication such as thyroid hormone medication, decongestants, asthma medications, and certain heart medications
  • substances such as caffeine and appetite suppressants
  • cocaine use
  • hyperthyroidism, which is an overactive thyroid gland
  • exercise
  • anemia, which is a low red blood cell count
  • defects in the electrical system of the heart
  • abnormalities of the heart muscle, known as cardiomyopathy
  • abnormalities in the heart valves

    • Risk of palpitations range from no risk to death. The determining factor is the nature of the palpitations, how long the runs are, and the location of the palpitations in the heart.

    Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of palpitations have been described as a flopping sensation in the chest and throat. It is rarely painful but usually associated with anxiety. Palpitations can be associated with the sensation of a rapid heart rate.

    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of the cause of palpitations starts with a history and physical exam. Many times the palpitations have stopped by the time the person seeks medical attention. But the healthcare provider will want to know the answers to these questions:

  • Are the palpitations continuous or do they come and go?
  • What was the person doing when they noticed the palpitations?
  • Was the heart rate fast or slow?
  • Were there any other symptoms such as shortness of breath, chest pain, excessive sweating, or dizziness?
  • Does the person have any medical problems?
  • What medications or drugs is the person taking now?
  • Is there an increase in stress in the person's life?
  • Does the person drink a lot of coffee, tea, or soft drinks with caffeine or eat chocolate?

    • The healthcare provider may conduct any of these tests to check the palpitations:

  • ECG, electrical recording of the heart, to detect current palpitations
  • chest x-ray to evaluate the size and shape of the heart
  • echocardiogram for an excellent picture of any underlying disease of the heart that might be present. An echocardiogram is especially useful in detecting cardiomyopathy, valvular disease, atherosclerosis, and high blood pressure.
  • thyroid function tests to rule out underlying thyroid problems
  • Holter monitor, a portable device worn by a person to monitor the ECG for at least 24 hours. The Holter monitor is useful because many times the palpitations have stopped by the time the person seeks medical care.
  • Event recorders, a recording device activated by the person at the time of the palpitations to record the event
  • EPS, or electrophysiologic study, for serious arrhythmias. Done in a special laboratory, this test maps the electrical activity of the heart.

    • Prevention & Expectations

    What can be done to prevent the condition?

    Prevention is related to the cause. For example, if palpitations are caused by anxiety, the use of an anti-anxiety medication may prevent this condition. Avoiding the precipitating factors such as certain medications, coffee, tea, or alcohol can prevent palpitations. Many causes cannot be prevented.

    What are the long-term effects of the condition?

    Sometimes palpitations may be a warning sign of underlying heart disease. If palpitations are caused by a problem with the heart, death can occur if the condition is not diagnosed and treated. In children, palpitations are usually more of a nuisance than a medical problem.

    What are the risks to others?

    There are no risks to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    The treatment depends on what's causing the condition:

  • If the cause of the palpitations is found to be anxiety or thyroid problems, medication to treat the condition (not the heart) may be given.
  • Palpitations from certain heart conditions may be treated with heart medications such as calcium channel blockers, beta-blockers and other anti-arrhythmic medications.
  • A person with atrial fibrillation may be given anticoagulation medications, or blood thinners.
  • Sometimes an electric charge may be delivered into the heart by external paddles, known as elective cardioversion. Or a radiofrequency pulse might be delivered through a catheter placed into the heart.

    • What are the side effects of the treatments?

    Side effects depend on the treatment used. Heart medications used to quiet the palpitations can cause worsening of the palpitations, life-threatening arrhythmias, swelling, severe allergic reactions, fatigue, dizziness, headache, and depression.

    What happens after treatment for the condition?

    Simple, intermittent palpitations require no treatment and have no long-term consequences. If the palpitations continue, then long-term follow-up is required. If the underlying disease is curable and the palpitations go away, no further treatment may be needed.

    How is the condition monitored?

    The person monitors the frequency of palpitations. Any irregularity lasting longer than a few minutes should be evaluated immediately by a healthcare provider. Medical help should be sought immediately if the person has chest pain, shortness of breath, excessive sweating, dizziness, or fainting. Regular visits to the healthcare provider to adjust heart medications may be required. Changes in the pattern, intensity, or duration of palpitations should be reported to the healthcare provider right away.

    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Wendel, Sandra J., BA
    Edit Date:07/09/00
    Reviewer:Eric Berlin, MD
    Date Reviewed:06/07/01

    Sources

    The Merck Manual of Medical Information, Home edition, 1997

    Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.

    Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

    Harrison's Principles of Internal Medicine, 1998, Fauci et al.