When Should I Be Worried About Heart Palpitations?

Reviewed on 1/26/2022

Woman sitting on a couch and holding her hands against chest
Heart palpitations are not a cause for concern unless you also experience symptoms such as chest pain or pressure, difficulty breathing/shortness of breath, lightheadedness/fainting near-fainting spells, dizziness, excessive sweating, swelling in your leg, fatigue, weakness, confusion, anxiety, or symptoms persist or frequently return.

Heart palpitations are a type of irregular heartbeat (arrhythmia) in which there is a change in the heart’s sequence of electrical impulses. 

Most of the time the heart palpitations are not a cause for concern and they only cause minor symptoms such as feeling:

  • As if you skipped a heartbeat
  • The heart is beating faster than normal
  • As if the heart is pounding in your chest
  • Fluttering in the chest or neck

However, there are some types of arrhythmias that can be signs of medical conditions: 

  • Tachycardia
    • Heart rate is too fast (in adults, more than 100 beats per minute)
  • Bradycardia
    • Heart rate is too slow (in adults, less than 60 beats per minute)
  • Atrial fibrillation (AFib)
    • Upper heart chambers contract irregularly
  • Ventricular fibrillation (VFib)
    • Disorganized contraction of the lower chambers of the heart
  • Conduction disorders
    • Heart does not beat normally
  • Premature contraction (PACs and PVCs)
    • Early heart beat

See a doctor right away if you have palpitations and:

What Causes Heart Palpitations?

Heart palpitations may be caused by:

Other types of arrhythmias may be caused by:

  • Heart attack
  • Heart changes with age
  • Congenital abnormality of the heart’s electrical system
  • Inherited heart disease

How Are Heart Palpitations Diagnosed?

Tests to diagnose the cause of heart palpitations include: 

  • Electrocardiogram (“ECG”) 
  • Echocardiogram (“echo”)
  • Stress test (treadmill test)
  • Electrophysiology test (EP study)
  • Esophageal electrophysiologic procedure
  • Tilt table test
  • Diagnostic monitors
    • Holter monitor
    • Transtelephonic monitor
  • Cardiac catheterization (“cardiac cath”) 
  • Magnetic resonance imaging (MRI) scan of the heart 
  • Computed tomography (CT) scan of the heart
  • Blood tests: brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) or cardiac enzymes such as Troponin 

What Is the Treatment for Heart Palpitations?

In many cases, no treatment is needed for heart palpitations and they go away on their own. 

When treatment is needed for certain arrhythmias, it may include:

  • Medications  
    • Antiarrhythmics
      • Class I (fast sodium channel blockers) 
      • Class II (beta-blockers)
      • Class III (potassium channel-blockers)
      • Class IV (calcium channel blockers)
      • Class V (other)
    • Anticoagulants (blood thinners) such as warfarin
  • Ablation
  • Cardioversion
  • Implantable devices

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Reviewed on 1/26/2022
References
Image Source: iStock Images

https://www.heart.org/en/health-topics/arrhythmia

https://www.amboss.com/us/knowledge/Antiarrhythmic_drugs

https://wexnermedical.osu.edu/blog/when-get-irregular-heartbeat-checked

https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2019/december/heart-palpitations