Less than half of the patients who present with palpitations have a heart-related underlying cause for palpitations. However, since some of these heart-related issues could be life-threatening, I recommend seeing a physician if you have palpitations. It is crucial to seek immediate care if palpitations are associated with symptoms of dizziness or episodes of passing out. You should also see a physician soon if you have a family history of heart rhythm disorders or a family member who suffered sudden cardiac arrest.
Some common heart-related causes of palpitations include additional beats from the heart, which may not be life-threatening but can cause quality life-limiting symptoms. Other heart-rhythm-related conditions like inappropriate sinus tachycardia (as seen in POTS), atrial fibrillation, supraventricular tachycardia (SVT), or ventricular tachycardia (VT) often need further evaluation and treatment.
More than half of the patients have non-heart-related causes of palpitations. These include dehydration, low blood sugar (hypoglycemia), pregnancy, anemia, infection, stress, sleep apnea, abnormal thyroid hormone levels, abnormal adrenal gland hormone levels, alcohol, smoking, medicines, and drugs. Excessive caffeine can occasionally cause heart palpitations. Alcohol or drug withdrawal is an uncommon cause of palpitations but could be life-threatening. The sensations of palpitations in these situations are often related to either a faster heart rate or stronger heartbeats. The underlying mechanisms are often associated with an increased body demand (e.g., infection, pregnancy), reduced oxygen supply through blood (e.g., dehydration, anemia, sleep apnea), direct stimulation of the heart leading to a higher heart rate (e.g., drugs, alcohol, caffeine), or a combination of the above mechanisms (e.g., abnormal thyroid hormone levels).
Other causes of palpitations include mental health issues like generalized anxiety disorder and panic disorder. Unfortunately, many patients are diagnosed with generalized anxiety disorder without a complete workup of the underlying causes.
Most of the causes of palpitations can be diagnosed with a history, physical examination, an EKG, and basic blood tests. An ultrasound of the heart (echocardiogram) and a heart monitor worn for a few days can assist with the diagnosis of heart-related causes of palpitations.
Dehydration:
Dehydration can cause the blood volume to decrease, causing the heart to work harder to pump blood throughout the body. Additionally, dehydration can cause palpitations by disrupting the electrolyte balance in the body.
To minimize palpitations caused by dehydration, it is essential to drink plenty of water and other fluids, such as electrolyte-rich sports drinks, to rehydrate the body and restore the electrolyte balance. It’s also crucial to avoid dehydration by drinking fluids regularly throughout the day, especially in hot weather or when engaging in physical activity.
Low potassium level:
Hypokalemia, or low potassium levels in the blood, can cause palpitations due to its effect on the heart’s electrical activity. Potassium plays a crucial role in maintaining the balance of electrical charges in the heart’s cells, which helps regulate the heart’s rhythm. When potassium levels are low, the heart’s electrical activity can become abnormal, leading to extra heartbeats and even abnormal heart rhythms.
To minimize palpitations caused by hypokalemia, treating the underlying potassium deficiency is essential. Increasing potassium intake through diet or supplements will reduce the risk of potassium inadequacy. Some strategies to boost potassium intake include:
– Eating potassium-rich foods such as bananas, oranges, sweet potatoes, spinach, and avocados
– Taking potassium supplements as directed by a healthcare provider
– Treating underlying medical conditions such as kidney disease, diabetes, or an eating disorder that may be contributing to the deficiency
– It’s also essential to avoid diuretics, laxatives, and other medications that can cause potassium loss, as they can exacerbate hypokalemia and its symptoms.
Food sensitivities:
Food sensitivity can cause palpitations by triggering an inflammatory response in the body. When the immune system identifies a particular food as a threat, it releases histamine and other inflammatory chemicals that can cause excessive relaxation of blood vessels (called vasodilatation), resulting in faster & stronger heartbeats.
To minimize palpitations caused by food sensitivity, it is essential to identify the specific foods causing the reaction and eliminate them from your diet. This can be done through elimination and reintroduction, where you eliminate a food for a while and then reintroduce it to see if it causes symptoms.
Another strategy is to take an antihistamine, which can help to reduce the inflammatory response and alleviate symptoms. Additionally, it is essential to manage stress and maintain a healthy lifestyle, as these can also contribute to palpitations.
Alcohol:
Alcohol can cause palpitations by causing changes in the heart’s electrical activity and excessive blood vessel relaxation (vasodilatation), resulting in a higher heart rate & stronger heartbeats. Additionally, alcohol can also cause inflammation and dehydration, which can exacerbate symptoms.
To minimize palpitations caused by alcohol, it is crucial to limit or avoid alcohol consumption. You can do this by limiting how much you drink or choosing non-alcoholic alternatives.
Low blood sugar:
Glucose is the primary energy source for the body’s cells. When blood sugar levels drop, the body releases adrenaline to raise them, which can cause the heart to beat faster and stronger, resulting in palpitations. To prevent episodes of low blood sugar, it is important to eat regular meals and snacks that balance carbohydrates, proteins, and fats. People with diabetes should also monitor their blood sugar levels and take steps to raise them if they become too low.
Sleep deprivation:
Sleep deprivation can cause palpitations by affecting the electrical activity of the heart. The lack of sleep can lead to increased stress hormones, such as cortisol and adrenaline, which can disrupt the heart’s normal rhythm and cause it to beat faster or irregularly. Sleep deprivation can also lead to changes in blood pressure, which can further contribute to palpitations.
To prevent episodes of palpitations caused by sleep deprivation, it is essential to prioritize getting adequate sleep each night. This includes sticking to a consistent sleep schedule, avoiding stimulating activities before bedtime, and creating a comfortable sleep environment. Also, relaxation techniques such as yoga, meditation, or deep breathing can help reduce stress and improve sleep quality.
It’s always best to consult with a healthcare professional to get a proper diagnosis and treatment plan for palpitations, including a thorough workup.
Postural orthostatic tachycardia syndrome:
POTS, or Postural Orthostatic Tachycardia Syndrome, is a condition in which a person’s heart rate increases significantly upon standing up, leading to symptoms such as heart palpitations, lightheadedness, and fainting. The exact cause of POTS needs to be better understood. Still, it is thought to be related to problems with the autonomic nervous system, which controls the body’s automatic functions, such as heart rate and blood pressure.
Treatment options for POTS include:
– Medications, such as beta-blockers, can slow heart rate and reduce symptoms.
– Fludrocortisone, a medication that helps the body retain salt and water to increase blood volume.
– Physical therapy to increase strength and improve posture.
– Compression stockings to help improve blood flow.
– Lifestyle changes include increasing fluid and salt intake, avoiding triggers such as caffeine and alcohol, and increasing activity levels.
Sleep apnea:
Sleep apnea can trigger heart palpitations and other associated symptoms due to the disruption of breathing during sleep. This disruption can cause a lack of oxygen in the body, leading to increased heart rate and blood pressure. Additionally, repetitive episodes of apnea can cause stress on the heart and cardiovascular system.
Other associated sleep apnea symptoms include daytime fatigue, morning headaches, difficulty concentrating, and irritability.
Treatment options for sleep apnea include continuous positive airway pressure (CPAP) therapy, which uses a machine to deliver pressurized air through a mask to keep the airway open during sleep. Oral appliances, such as a mandibular advancement device, can also be used to reposition the jaw and tongue to keep the airway open. Surgery may also be an option for some individuals.
The effectiveness of treatment options for sleep apnea varies depending on the individual and the severity of their condition. CPAP therapy is generally considered the most effective treatment option, with a success rate of 80-90%. Oral appliances and surgery can also be effective but may not be suitable for everyone.
Thyroid dysfunction:
Thyroid dysfunction, either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), can cause heart palpitations and other symptoms such as fatigue, weight changes, and mood swings. The specific treatment options and their effectiveness vary depending on the type of thyroid dysfunction.
For hyperthyroidism, treatment options include medication to block the production of thyroid hormones, radioactive iodine to destroy overactive thyroid cells, and surgery to remove part or all of the thyroid gland. These treatments are generally effective in controlling symptoms and normalizing thyroid hormone levels.
Treatment for hypothyroidism typically involves taking synthetic thyroid hormone (levothyroxine) to replace the hormones the thyroid is not producing. This treatment is usually effective in controlling symptoms and normalizing thyroid hormone levels. Still, it may take several weeks or months for the full effects to be seen.
Anemia:
Anemia, or a lack of sufficient red blood cells in the body, can trigger heart palpitations because the heart has to work harder to pump oxygen-poor blood through the body. This can also cause fatigue, weakness, and shortness of breath. Treatment options for anemia include:
- Increasing iron intake through diet or supplements.
- Taking medications increases the production of red blood cells and, in severe cases.
- Receiving blood transfusions.
The effectiveness of treatment options depends on the underlying cause of the anemia. In some cases, treating the underlying condition will also treat the anemia.
Chronic fatigue syndrome:
Chronic fatigue syndrome (CFS) is a complex condition that can cause many symptoms, including heart palpitations. Several factors, including stress, anxiety, and hormonal imbalances, may cause these palpitations.
Other associated symptoms of CFS that may trigger heart palpitations include:
Fatigue: CFS is characterized by severe and persistent fatigue not relieved by rest.
Pain: Many people with CFS experience chronic pain, which can also trigger palpitations.
Sleep disturbances: CFS can cause insomnia, which can lead to palpitations.
Depression and anxiety: CFS can cause emotional and psychological symptoms and trigger palpitations.
Treatment options for CFS and heart palpitations include:
– Medications: Antidepressants, beta-blockers, and other medications may be used to treat heart palpitations.
– Cognitive-behavioral therapy: This therapy can help people with CFS learn to manage stress and anxiety, which can trigger palpitations.
– Exercise: Regular exercise may help to reduce fatigue and improve overall health.
Nutrition: Eating a balanced diet may help to reduce symptoms and improve overall health.
Long COVID:
Post-covid 19 syndrome, also known as long COVID, can trigger heart palpitations and other associated symptoms such as fatigue, shortness of breath, chest pain, and anxiety. The mechanism likely involves inflammation of blood vessels and lack of responsiveness of receptors that respond to adrenal gland hormones.
Treatment options for post-covid 19 syndromes include:
Medications: Antiviral drugs, immunomodulators, and anti-inflammatory drugs can reduce inflammation and improve symptoms.
Physical therapy: Rehabilitation exercises and breathing techniques can help improve lung function and reduce fatigue.
Psychological support: Counseling and therapy can help manage anxiety and depression symptoms.
Oxygen therapy: Oxygen therapy can improve oxygen levels in the blood and reduce shortness of breath.
Pregnancy:
Pregnancy can trigger heart palpitations due to increased hormonal levels, blood volume changes, and the heart’s workload. These changes can cause the heart to beat faster or irregularly, leading to palpitations.
Treatment options for heart palpitations during pregnancy include:
Lifestyle changes: Making changes to your lifestyle, such as reducing stress, avoiding caffeine and nicotine, and maintaining a healthy diet, can help reduce the frequency and severity of palpitations.
Medications: In some cases, beta-blockers or calcium channel blockers may be prescribed to help regulate the heart rate and reduce palpitations.
Premenstrual syndrome (PMS):
Hormonal fluctuations can cause heart palpitations during PMS, specifically an increase in estrogen and progesterone levels. These hormones can cause an increase in heart rate and blood flow, leading to feelings of fluttering or racing in the chest.
Other associated symptoms of PMS that may contribute to heart palpitations include anxiety, stress, and fatigue. These symptoms can cause the body to release stress hormones, such as adrenaline, which can also contribute to heart palpitations.
Treatment options for PMS-related heart palpitations include:
Hormonal birth control: Birth control pills can help regulate hormone levels and reduce the severity of PMS symptoms.
Exercise: Regular physical activity can help reduce stress and anxiety, which can contribute to heart palpitations.
Relaxation techniques: Techniques such as yoga, meditation, and deep breathing can help reduce stress and anxiety, which can contribute to heart palpitations.
Medications: Anti-anxiety medications and antidepressants may be prescribed to help reduce symptoms of anxiety and depression, which can contribute to heart palpitations.
Additionally, lifestyle changes such as maintaining a healthy diet, getting enough sleep, and reducing alcohol and caffeine intake can help alleviate symptoms.
Menopause:
Menopause can trigger heart palpitations due to the hormonal changes that occur during this stage of life; as estrogen levels decrease, the risk of heart palpitations increases. Other associated symptoms of menopause that may trigger heart palpitations include hot flashes, night sweats, and anxiety.
Treatment options for heart palpitations associated with menopause include hormone replacement therapy (HRT), which can help to balance estrogen levels and reduce the risk of heart palpitations. Other options include medications such as beta-blockers, which can help to slow the heart rate and reduce palpitations.
Lifestyle changes, such as regular exercise, eating a healthy diet, and avoiding triggers such as caffeine and alcohol, can also reduce the frequency and severity of heart palpitations.
