When To Worry About Heart Palpitations

Anyone who’s felt as though their heart was beating too hard or too fast, skipping a beat or fluttering, knows the feeling can be unsettling — or even downright frightening. But these off-beat heartbeats don’t necessarily signal something serious or harmful, and often they go away on their own.

Most of the time, a random skipped beat here and there can be caused by stress or too many stimulants, such as caffeine or nicotine, says cardiologist Justin Lee, MD. Though uncomfortable, these are often nothing to worry too much about.

When palpitations are accompanied by other symptoms, though, it’s time to see a healthcare specialist.

We talked with Dr. Lee and pediatric cardiologist Peter Aziz, MD, about what signs to look out for and when to worry about heart palpitations.

What are heart palpitations?

Heart palpitations are the feeling you have when your heartbeat is off beat.

“A palpitation is the sensation that the heart is beating faster or harder than normal,” Dr. Aziz says. “Some people describe them as a fluttering, pounding or flip-flopping sensation. Or it may feel as if your heart skipped a beat or took an extra beat.”

Sometimes, heart palpitations can be a sign of an arrhythmia (a heart rate that is faster or slower than normal).

Why would that happen? It’s a matter of your heart’s electrical system.

Much like an orchestra maestro synchronizes complex sounds into a well-tuned symphony, electrical signals in your heart synchronize muscle contractions. The result is the rhythmic lub-dub lub-dub of your heartbeat. The electrical system has to hit each note in a highly regulated fashion for your heart to function effectively and efficiently.

Your heart’s electrical system runs on the equivalent of railroad tracks. People with arrhythmias often have extra electrical connections. Arrhythmias can occur when the electrical system uses these bonus connectors.

Instead of the heart beating at a normal rate, those extra electrical connections can cause your heart to suddenly race at high speed. The result is a rapid and uncomfortable increase in heart rate and the feeling of heart palpitations.

Signs to watch out for

It’s common to experience short-lived palpitations that aren’t accompanied by a faster-than-usual heart rate or other symptoms. Those aren’t a cause for much concern.

“Not all palpitations are considered abnormal,” Dr. Aziz notes. “It’s common for the heart to skip for single beats, causing an unusual sensation. With rare exceptions, these single-skipped beats are considered normal.”

There are times, though, when palpitations should be a sign to seek medical attention. Drs. Lee and Aziz explain the difference.

High heart rate

If you’re experiencing palpitations, Dr. Lee suggests checking your heart rate by feeling your pulse or using a smartwatch or other heart monitoring device. A heart rate that’s higher than 110 beats per minute can be a sign of an arrhythmia and should be checked by a healthcare provider.

Long-lasting

Normal palpitations shouldn’t last longer than a few minutes. Palpitations that continue for an hour or more — even without other symptoms — should be evaluated further.

Age considerations

Dr. Lee says that heart palpitations that appear suddenly in older adults should be checked by a healthcare provider. This is particularly true for people who don’t have a history of experiencing palpitations.

“If you haven’t been feeling palpitations throughout your adult life and at 60 or 70 years old and now you’re experiencing them, the chances are higher that you’re experiencing atrial fibrillation, an irregular heart rhythm in the upper heart chambers,” he continues. “I’d recommend a more thorough evaluation in those cases.”

Atrial fibrillation is one of the most common kinds of arrhythmia and can lead to a stroke and other complications if left untreated.

Other symptoms

Palpitations that are accompanied by other symptoms can be a big, fat red flag of an arrhythmia. Don’t ignore palpitations that come along with symptoms like:

• Chest pain or discomfort.
• Dizziness.
• Feeling lightheaded.
• Fainting.

“If your palpitations are accompanied by severe symptoms, it’s a sign of instability, and we would recommend getting to an emergency room for testing,” Dr. Lee states.

Seeking medical attention

If you can manage your short-lived palpitations through things like cutting back on the coffee and managing your stress, they shouldn’t be anything to worry about. A mention to your doctor at your next checkup can suffice.

But if your palpitations don’t stop on their own, or you’re experiencing them at an older age, a call to a doctor should be in order.

Emergency situations include palpitations that are painful or make you feel “off.”

To assess what’s at the heart of your palpitations, your healthcare provider will obtain a detailed history and will likely perform an electrocardiogram (EKG). That’s a noninvasive study that looks at the electrical conduction of your heart in its resting state.

If your healthcare provider suspects an arrhythmia, they may recommend you wear a monitor for a few days. An ambulatory monitor is a wearable device that records the electrical activity in your heart during an episode.

When in doubt, it’s never a bad idea to share your questions or concerns about heart palpitations with a healthcare provider. While your palpitations may be nothing to worry about, a healthcare provider can help identify the cause of your fluttering and help you find ways to manage it.