By Hafeza Shaikh, DO, FACC, RPVI, FACOI, Virtua Cardiology

You’re usually not aware that your heart is beating. So any time you experience a palpitation—the feeling of having a fast-beating, fluttering or pounding heart—it’s understandably disconcerting.

Most palpitations are not dangerous and can be explained by external factors. But they can be a sign of a potentially serious condition that requires a closer look.

Pinpointing palpitations
Palpitations can occur at any time, whether you are simply sitting or going about your daily activities. They can be felt in your chest, throat, or neck. Heart palpitations may be caused by:

• Emotions, such as anxiety, stress, fear, or panic
• Strenuous exercise
• Hormone changes associated with pregnancy, menopause, or menstruation
• Caffeine found in coffee, tea, chocolate, cola, and some sports drinks
• Certain medical conditions, including overactive thyroid (hyperthyroidism); low blood sugar, potassium, oxygen, or carbon dioxide levels in the blood; fever; anemia; dehydration; loss of blood; and shock
• Certain medications, such as asthma inhalers and decongestants; thyroid medications; some over-the-counter medications that act as stimulants, including cough and cold medicines; and particular herbal or nutritional supplements. In some people, beta-blockers (taken for high blood pressure or heart disease) and other antiarrhythmic drugs may cause or worsen palpitations.
• Illegal street drugs like cocaine and amphetamines (speed)
• Nicotine

Often, lifestyle changes will reduce or eliminate the palpitations, such as cutting out coffee, not smoking, or changing medications. But sometimes we discover there is an underlying medical condition, such as anemia or overactive thyroid, that we can address.

When the beat Is truly off
If your heart skips a beat and you feel light-headed, dizzy, breathless, or weak, you may have an arrhythmia, or abnormal heart rhythm.

Arrhythmias are the result of irregular electrical signals in the heart. They may cause a rapid heart rate (tachycardia), an unusually slow heart rate (bradycardia) or an irregular rhythm called atrial fibrillation (AFib). AFib makes you five times more likely to have a stroke, as well as develop heart failure.

It can be difficult for your doctor to determine the cause of palpitations, especially if they are not experienced during an office visit. Your doctor may order an electrocardiogram, blood tests, or an exercise stress test.

You also may be asked to wear a Holter monitor, which uses electrodes attached to your chest to record your heart activity for 24 hours to 60 days, and keep a diary of when you experience symptoms.

Some patients whose symptoms cannot be explained may be eligible for an implanted cardiac monitor (also called an insertable loop recorder). These recorders, which are smaller than a triple A battery, can be left in place for several years and wirelessly transmit data for your doctor to review.

Restoring your rhythm
Treatment of your palpitations will depend on your symptoms and their underlying cause. Your doctor may recommend lifestyle changes or medications, such as blood thinners, beta-blockers, and calcium channel blockers. You will need to work closely with your doctor to find out which medicine works best for you.

A minimally invasive medical procedure called an ablation destroys abnormal heart tissue causing the errant electrical signals. If indicated, other options include implanting a pacemaker or implantable cardioverter defibrillator, which detects irregular heartbeats and sends an electrical shock to restore your rhythm.

While palpitations usually aren’t life-threatening, their symptoms can mimic a heart attack or other serious problem. If you experience symptoms such as shortness of breath, dizziness, chest pain, or fainting, call 911 right away.

Virtua Health’s electrophysiology labs offer the full range of cardiac rhythm management with diagnostic and therapeutic interventions, utilizing the most advanced equipment and techniques.

Call 844-932-8444 to make an appointment with a Virtua electrophysiologist and get back to the normal rhythm of your life.