The 411 on heart palpitations

From everyday stress to watching your favorite sports team, heart palpitations can be caused by a wide-range of situations. Although they may seem minor at the time you’re experiencing them, prolonged palpitations may be a symptom of a more serious health concern, such as a cardiac  arrhythmia. Defining the source of palpitations is key to developing a course of action to treat future occurrences.

Cardiac and non-cardiac causes of palpitations

A heart palpitation is a perceptible unpleasant forcible pulsation of the heart, usually with an increase in frequency or force, with or without irregularity in rhythm. Dr. Ajith Nair, assistant professor of cardiology at Baylor College of Medicine, says heart palpitations can occur as a result of both cardiac and non-cardiac causes.

Cardiac causes include:

• Arrhythmias
• Cardiac and extracardiac shunts
• Valvular heart disease
• Pacemakers
• Atrial myxoma
• Cardiomyopathy
• Congenital heart disease

Non-cardiac causes include:

• Panic disorders
• Anxiety disorders
• Somatization (mental illnesses that cause bodily symptoms)
• Depression

Nair says certain medication can also play a role.

“If you’re taking albuterol for asthma, it can sometimes cause palpitations, for example,” he said. Other medications that have potential to cause palpitations are sympathomimetic drugs, vasodilators and anticholinergics.

“Always be mindful of some of the things that you take, whether they are prescription-based or over-the-counter,” Nair said.

Other risk factors for palpitations include anemia, pregnancy, Paget’s disease, and metabolic disorders such as hypoglycemia. If you feel like you experience extra heartbeats when you exercise, it may be something that warrants further evaluation.

“When we exercise we have a catecholamine surge, which can cause extra heartbeats. If it’s one or two beats here and there it may be an electrolyte issue, but we also look out for whether exercise brings out sustained arrhythmias,” Nair said.

Types of arrhythmias

There are two types of arrhythmias that cardiologists often look for – atrial arrhythmias and ventricular arrhythmias.

Premature atrial contractions (PACs) are extra beats that come from the top part of the heart, and are usually in isolation. Premature ventricular contractions (PVCs) are extra beats that come from the bottom part of the heart.

“If a patient is experiencing multiple PVCs, we start getting concerned about sustained arrhythmias occurring. Anything from the bottom part of the heart that’s abnormal is more worrisome than the top part of the heart,” Nair said.

Treatment and prevention

Depending on the nature, severity and frequency of your palpitations, a variety of diagnostic testing may be performed by your cardiologist. Nair says palpitations occurring due to a life-threatening condition are not common.

“If you’re occasionally having one or two palpitations, therapy is most likely not needed. If they are happening for longer periods of time quite frequently, then you may be experiencing a sustained arrhythmia,” he said.

The evaluation for palpitations and arrhythmias may be an echocardiogram (ultrasound of the heart) to exclude structural heart problems, a home heart monitor, or a treadmill test. If a true arrhythmia is detected, further testing as well as consultation with a cardiac electrophysiologist may be necessary.

Anti-arrhythmic drugs can be prescribed for true arrhythmias. A cardiac electrophysiologist may also perform procedures such as an ablation to permanently remove the source of an arrhythmia.

In most cases, however, infrequent palpitations may be treated with limiting stress, reducing caffeine consumption and a healthy diet.

Additional resources

Check out six small ways you can improve your heart health.

High blood pressure and heart health: What you need to know.

What do terms like cholesterol, triglycerides, HDL, LDL, systolic and diastolic mean? Find out how they represent your heart health.

Get more insight into heart health.

-By Nicole Blanton