Heart Palpitations

Heart palpitations are when you become aware of your heartbeat. You can distinctly feel these beats that you normally don’t notice. Most commonly, simple causes such as excessive caffeine intake, excitement, fear, stress, exercise, anxiety, and hormonal changes cause palpitations. However, sometimes they can be a sign of underlying serious rhythm disorders or structural heart diseases.

When you experience heart palpitations, the first question that usually comes to mind is “Is this normal palpitation, or is it a dangerous condition?” There are basic clues that will help you distinguish palpitations. Let’s look at them together.

Physiological palpitations usually occur with specific triggers and last for a short time. Palpitations experienced during excessive caffeine consumption, excitement, fear, anger, or anxiety situations fall into this group. These palpitations last for a few minutes, start slowly, and pass on their own when the triggering factor is removed. You feel your heart speeding up, but the rhythm is regular.

Palpitations due to rhythm disorders are different. They can start suddenly at rest and end just as suddenly. Heart beats may become irregular or there may be interruptions in rhythm. You may experience the feeling that your heart “skipped” or “stopped.” Sometimes palpitations can occur alone, sometimes with chest pain, shortness of breath, dizziness, or fainting.

Palpitations due to structural heart diseases manifest with additional symptoms. If you feel shortness of breath, chest pain, extreme fatigue, or fainting along with palpitations, the possibility of heart problems increases. In these cases, palpitations may continue even at rest and may limit your daily activities.

Points to be careful about:

• Sudden palpitations that start during rest without a trigger can be dangerous.
• Palpitations that are triggered by a specific cause and start slowly are usually physiological.
• Palpitations that stop suddenly can be a warning sign.
• Palpitations that gradually return to normal suggest physiological palpitations.
• Short-lasting palpitations (a few seconds or minutes) are mostly harmless.
• Palpitations lasting 15-30 minutes or longer should be evaluated.
• Palpitations accompanied by chest pain, shortness of breath, dizziness, or fainting are dangerous. You should seek immediate medical attention.

The vast majority of palpitations are not dangerous and can be controlled with lifestyle changes. However, in case of doubt, consulting a specialist is definitely the right step.

Why Do Heart Palpitations Occur?

The causes leading to heart palpitations are quite extensive. Many different conditions, from the most innocent to the most serious, can trigger this feeling.

• Coffee, tea, energy drinks, and other beverages with high caffeine content are among the most common causes of palpitations. More than three cups of coffee per day can significantly cause palpitations in sensitive individuals.
• Nicotine found in cigarettes and tobacco products speeds up heart rate and can lead to palpitations.
• Alcohol consumption, especially when consumed in large amounts, disrupts heart rhythm and creates a feeling of palpitations.
• Intense stress, excitement, fear, anger, and other emotional states are strong triggers of palpitations. These conditions cause adrenaline to be released in your body. This hormone increases heart rate and creates a strong feeling of palpitations.
• Anxiety and panic attack conditions especially lead to prominent palpitations. In these situations, heartbeats are felt so strongly that the person may worry that “my heart will stop.”
• In febrile illnesses, each degree increase in body temperature speeds up heart rate by 10-15 beats.
• In anemia, the heart tries to meet oxygen needs by working faster and can cause palpitations.
• Overactivity of the thyroid gland (hyperthyroidism) causes a significant increase in heart rate. Patients with this condition may constantly experience palpitations.
• Many medications, from asthma drugs to cold drops, from antidepressants to painkillers, can show palpitation side effects.
• Heart and vascular diseases are among the more serious causes of palpitations. Conditions such as heart rhythm disorders, heart valve diseases, and coronary artery disease can cause palpitations. In these cases, palpitations are usually seen together with other symptoms.
• Hormonal fluctuations during menstrual periods, pregnancy, menopause can create a feeling of palpitations.

What Are the Symptoms of Heart Palpitations?

The symptoms of heart palpitations vary from person to person and can be experienced in different ways.

• The feeling of rapid heartbeat is the most common symptom you encounter. You can feel your heart beating much faster than normal, and you can feel this in your chest, neck, or wrist pulse.
• The feeling of irregular beating is when your heart loses its normal rhythm. For example, in a rhythm disorder called atrial fibrillation, heartbeats become completely irregular.
• The feeling of skipped beats is a pause that occurs after early heartbeats. You feel like “the heart stopped” or “a beat was lost.” Usually, a stronger beat comes right after this feeling. PVCs cause this feeling.
• Your heart beating slower than normal can also lead to a feeling of palpitations. This condition is called bradycardia and can be accompanied by complaints such as weakness, dizziness, or fainting.
• The feeling of pulse in the neck and throat area is one of the characteristic findings of palpitations. You notice blood flow in your neck vessels. You describe it as “my pulse is beating in my throat” or “my vessels are bulging.”
• Chest discomfort can develop along with palpitations. You may experience a slight feeling of tightness, pressure, or tension in your chest.
• Difficulty breathing is especially seen in rapid palpitations. Your heart’s rapid work increases your oxygen need and you may experience the feeling of “I can’t breathe.”
• You may experience dizziness and weakness. Changes in heart rhythm can affect blood circulation. Mild confusion, weakness, or the feeling that “my legs won’t support me” may develop.
• Sweating and feeling of heat occurs due to nervous system reaction. You may experience cold sweats, facial flushing, or sudden hot flashes.
• Feelings of anxiety and fear form the psychological dimension of palpitations. The heart beating differently causes anxiety in you and the thought “something will happen” may develop.

Why Do Occasional Heart Palpitations Occur?

Occasional heart palpitations you experience are mostly due to daily life factors such as stress, excitement, excessive caffeine consumption, insomnia, hunger, or strenuous exercise. These types of palpitations usually last for a short time and pass on their own with rest.

However, if palpitations recur frequently or you experience complaints such as fainting or dizziness along with them, the possibility of an underlying rhythm disorder or another heart disease should be considered. In this case, it is important to consult a cardiology specialist.

Why Do Heart Palpitations Start When Lying Down?

Heart palpitations that start when lying down can generally occur due to more blood coming to the heart when you move to a horizontal position and this creating short-term pressure in the heart. Conditions such as premature beat, reflux, thyroid diseases, anemia, insomnia, blood pressure fluctuations, hormonal changes, and anxiety can also cause your night palpitations to increase. Additionally, at night in a quiet environment, environmental stimuli decrease and you may feel your heartbeats more prominently.

Why Do Heart Palpitations Occur at a Young Age?

Heart palpitations at a young age are mostly due to harmless and physiological causes. In situations such as excitement, stress, exam anxiety, intense exercise, insomnia, excessive caffeine or energy drink consumption, you may feel your heartbeats faster and stronger. Additionally, conditions such as overactive thyroid hormones, anemia, vitamin deficiencies, or anxiety can also increase palpitations at a young age. Rarely, congenital heart rhythm disorders can cause palpitations in young people.

What Helps Heart Palpitations? How Do They Pass?

Some precautions in daily life can reduce palpitations. Getting enough sleep, staying away from stress, exercising regularly, and avoiding cigarettes/caffeine can relieve palpitations. When palpitations are felt, taking deep breaths, resting briefly, or drinking water can help palpitations.

• Deep and slow breathing calms your nervous system and helps palpitations. Breathe in for four seconds, hold for four seconds, exhale slowly for eight seconds. Continue this cycle for five to ten minutes.
• Abdominal breathing slows your heart rate and helps you relax. Put your hand on your stomach and feel your stomach rise when you breathe in.
• Cold application can slow heartbeats by stimulating the vagus nerve. Splash cold water on your face or apply a cold compress to your neck.
• Position changes such as slightly raising your legs regulate circulation.
• The Valsalva maneuver can reduce heart rate in fast rhythms like SVT. Keep your nose closed and push your breath for 10-15 seconds as if you’re exhaling deeply.
• Relaxation methods reduce stress-related palpitations. Try muscle relaxation exercises and breathing exercise techniques.
• Staying away from triggering factors such as caffeine, energy drinks, cigarettes, and stress is important in stopping palpitations.
• Move to a quiet, cool environment, loosen tight clothing, and open the window to get fresh air. Environmental arrangements help you feel your heartbeat less.
• Adequate fluid intake prevents dehydration-related palpitations. Drink regular and adequate amounts of water throughout the day, avoid very cold drinks.
• Slow walking and stretching exercises reduce muscle tension. Light movement can balance heart rhythm in some cases.
• Foods containing potassium and magnesium (bananas, avocados, spinach) support electrolyte balance.
• Regular sleep helps the body cope with stress.
• Some herbal teas and natural products can show calming effects (lemon balm tea, chamomile tea, linden tea, etc.).

How Is the Cause of Heart Palpitations Understood?

To understand the cause of your palpitations, first a detailed history is taken from you. Information such as when your palpitations started, how long they lasted, in which situations they occurred, and whether there are other symptoms along with them is very important in making a diagnosis.

Then your physical examination is performed and an ECG is taken. However, ECG can only show rhythm if you have palpitations at that moment. If your palpitations come in attacks, a 24-hour or 7-day rhythm holter is attached to record your heart rhythm in daily life.

In some cases, echocardiography may be performed to examine the structure of your heart. More rarely, additional tests such as tilt test or stress test may also be requested.

Not all of these tests need to be performed on everyone. Which ones are necessary is determined according to your condition and your doctor’s evaluation.

How Is Heart Palpitation Treatment Done?

Your treatment is planned according to the cause of your palpitations. If your palpitations are caused by physiological reasons, regulating your lifestyle, reducing stress, and staying away from caffeine and cigarettes is usually sufficient.

If your palpitations are due to other diseases such as anemia or thyroid disorder, first the treatment of these underlying problems is done.

If a rhythm disorder is detected in you, in this case, drug treatment, electrophysiological study, or in some cases, interventional methods such as catheter ablation may come into question. In some rhythm disorders such as atrial fibrillation, you may need to use blood thinning medications to prevent clot formation in the heart.

Frequently Asked Questions

Why do psychological heart palpitations occur?

Heart palpitations due to psychological causes usually occur during stress, anxiety, panic attacks, or intense emotional situations. Emotions such as excitement, fear, or anxiety increase adrenaline release in your body. This hormone also speeds up your heartbeats and leads to a feeling of palpitations.

In some periods, especially when you experience intense stress in your life or your anxiety level increases, you may feel your heart’s beats stronger and faster. When environmental stimuli decrease (for example, when lying down at night), this feeling can become even more prominent.

Which deficiencies cause palpitations?

Heart palpitations can result from various mineral and vitamin deficiencies. Among these, magnesium, potassium, iron deficiency, vitamin B12, and vitamin D can be counted.

What are the causes of the feeling of the heart beating in the throat?

Especially in thin people, the carotid arteries in the neck area becoming more prominent with palpitations is a commonly encountered situation. This can generally result from lifestyle factors such as stress, anxiety, excessive caffeine consumption. Apart from this, medical conditions such as heart rhythm disorders, thyroid problems, blood pressure changes can also lead to the feeling of the heart beating in the throat. Conditions such as reflux, anemia, or side effects of some medications can also cause such symptoms.

If this feeling recurs frequently or is seen together with more serious symptoms such as dizziness, chest pain, shortness of breath, it is important to have a cardiology examination. Proper evaluation of such conditions is necessary for the detection of potential underlying health problems.

What are the rhythm disorders that cause heart palpitations?

Heart rhythm disorders that cause palpitations are:

• Supraventricular Tachycardias (AVNRT, AVRT, AT, nodal tachycardia)
• Atrial premature beat (also called PACs)
• Atrial fibrillation
• Atrial Flutter
• Ventricular premature beat (PVCs)
• Ventricular tachycardia
• Low pulse rates (cause palpitation feeling due to slow but strong heartbeats)

How is psychological heart palpitation distinguished?

Psychological palpitations usually occur with specific triggers (for example, stressful situations) and can be seen together with anxiety symptoms (sweating, trembling). These types of palpitations can be alleviated with methods such as relaxation techniques or deep breathing. Additionally, regular meditation, yoga, or stress management exercises can also be effective in controlling psychological palpitations.

Are heart palpitations dangerous?

If you have a known heart-related condition, for example, if you have had a heart attack before, if you have growth or enlargement in your heart, if there is a serious problem with your heart valves, or if you have a pacemaker, every palpitation felt is important and must be carefully evaluated. In this case, palpitations can sometimes trigger dangerous rhythm disorders.

Reference: Palpitation