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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The heart needs its normal environment to work well. This is especially true for the heart's electrical system; changes in electrical conduction may lead to a decreased ability for the heart to pump blood.

From within the body, abnormal levels of electrolytes like potassium, magnesium, and calcium can cause palpitations. Anemia and hyperthyroidism are also a potential causes of palpitations.

Since we live in a very chemical world, many of the substances that we put into our body can cause palpitations by appearing to act like adrenalin on the heart and make it irritable. Common stimulants include:

• caffeine;
  
  
• tobacco;
  
  
• alcohol;
  
  
• over-the-counter medications such as pseudoephedrine, which is found in cold preparations and some herbal medications, including ma huang; and
  
  
• illicit drugs including: cocaine, amphetamine, PCP, and marijuana, among others, also can cause palpitations.

The use of some prescription medications needs to be monitored, since their side effects can cause palpitations. Asthma medications like albuterol inhalers or theophylline and thyroid replacement medications are common causes of palpitations.

Times of stress can increase adrenalin levels in the body and cause rapid heart beats. These are physiologic and may be due to exercise, illness, or emotional stressors.

Specific types of palpitations may be due to structural abnormalities in the heart. Narrowing of the coronary arteries that causes a decreased blood supply to the heart muscle can cause irritability and abnormal heart beats like premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation. Structural wiring abnormalities can cause paroxysmal supraventricular tachycardias or Wolfe-Parkinson-White syndrome.

Heart valve abnormalities can also cause irregular heart beats. Up to 40% of persons with mitral valve prolapse complain of palpitations.

Women who are pregnant often experience palpitations and most often, no dangerous rhythm disturbance is present. However, for women who had underlying heart rhythm issues before their pregnancy, the frequency of the palpitations may increase because of the normal changes in hormone levels and changes in the blood flow that occur as the heart adapts to pumping blood to the uterus and developing fetus.

Changes in hormone levels a woman's body before, during, and after menopause can also increase the frequency of palpitations.

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