Heart racing or skipping a beat? What palpitations may mean

Heart palpitations often are harmless, but symptoms that are frequent, worsening or accompanied by chest pain, severe shortness of breath, dizziness or fainting require medical attention.

Have you ever felt as though your heart was pounding, racing, fluttering or skipping a beat? These sensations are known as heart palpitations.

Palpitations are common and can happen to anyone, including people without heart disease. Although they can feel unsettling, most episodes are brief and harmless. However, recurring palpitations or those accompanied by other symptoms may need medical evaluation.

What causes heart palpitations?

Heart palpitations are more common in older adults, but they can affect people of any age. In many cases, the exact cause is unknown. According to the American Heart Association (AHA), palpitations may be triggered by factors in your daily life, such as:

• Caffeine, energy drinks or alcohol
• Certain medications, including some decongestants, asthma medicines and stimulants
• Dehydration or electrolyte imbalances
• Fatigue or lack of sleep
• Fever or illness
• Hormonal changes associated with menstruation, pregnancy or menopause
• Illegal stimulants such as cocaine or methamphetamine
• Nicotine and other tobacco products
• Strenuous exercise
• Stress, anxiety or panic
• Strong emotions

Medical conditions unrelated to the heart can also trigger palpitations, including anemia, low blood sugar, an overactive thyroid, lung disease and electrolyte imbalances.

But, sometimes, palpitations do indicate an underlying heart issue. Abnormal heart rhythms called arrhythmias can be caused by electrical malfunctions in your heart through conditions called atrial fibrillation (AFib) or ventricular tachycardia. Palpitations can also be caused by congenital heart problems, heart failure or heart valve disease.

When heart palpitations need medical attention

An occasional sensation that lasts only a few seconds and is not accompanied by other symptoms is usually not an emergency. Still, mention it at your next medical appointment, especially if it is new.

Contact a doctor if your palpitations:

• Keep coming back or are becoming more frequent
• Last longer than a few minutes
• Affect your sleep, exercise or daily activities
• Occur with lightheadedness or unusual fatigue
• Begin after starting a new medication or supplement
• Occur when you have a personal or family history of heart problems

Before your appointment, keep a record of your symptoms, including:

• When each episode starts and how long it lasts
• What the sensation feels like
• What you were doing at the time
• Whether you had recently consumed caffeine, alcohol or medication
• Any accompanying symptoms

This information can help your doctor identify patterns and possible triggers.

Call 911 or head to the nearest emergency room if your heart palpitations are accompanied by any of these symptoms:

• Chest pain, pressure or tightness
• Fainting or near-fainting
• Severe dizziness or lightheadedness
• Severe or sudden shortness of breath
• Sudden weakness, confusion or other concerning symptoms

These symptoms may signal a serious heart rhythm problem, heart attack or another condition that requires immediate care.

How are palpitations evaluated?

Your doctor will ask about your symptoms, medical history, medications, supplements and possible triggers. They may also perform a physical examination and order blood tests to look for causes.

During your evaluation, you may need one or more tests:

• Echocardiogram: An ultrasound that creates pictures of your heart and can help find problems with its structure or valves.
• Electrocardiogram: An ECG or EKG records your heart's electrical activity and can detect an abnormal heart rhythm.
• Holter monitor: This small, portable device records your heart rhythm continuously, usually for one or more days.

How are heart palpitations treated?

Treatment depends on the cause. If testing does not identify a heart condition, treatment may simply involve avoiding known triggers and monitoring symptoms.

If you have heart disease or an abnormal heart rhythm treatment may include:

• An implanted pacemaker or defibrillator
• Cardioversion to restore a normal heart rhythm
• Catheter ablation to treat the area causing an abnormal rhythm
• Medication

What can I do to stop heart palpitations?

Once serious causes have been ruled out, you can take a few simple steps to help manage your palpitations:

• Get consistent, adequate sleep
• Keep a symptom diary to identify patterns and triggers
• Limit or avoid alcohol
• Manage stress through breathing exercises, meditation or other relaxation techniques
• Reduce caffeine and energy drinks
• Review medications and supplements with a physician
• Stay hydrated
• Stop smoking or using nicotine products