When To Worry About Heart Palpitations & Know When They Are an Emergency

Palpitations are moments where it feels like your heart is overactive, pounding, fluttering or otherwise acting more than it should; you may even think you're having a heart attack. You may be able to sense it within your chest, your throat or even your neck. You might also feel like your heart is skipping beats, beating too erratically or even too heavily. Furthermore, palpitations can manifest at any level of activity, whether you are working out, sitting at a desk or even lying in bed. A normal human heart beats between 60 and 100 beats per minute (BPM); anything faster than 100 BPM is a rate that the human body cannot safely sustain.

What Are Heart Palpitations and What Causes Them?

It is perfectly normal to experience the occasional heart palpitation; they are usually harmless and tend to dissipate without anything being done to them. While experiencing palpitations can be alarming, especially for people unaware of how they are caused, we have provided a list of what causes heart palpitations.

  • Anemia

  • An intense exercise routine

  • Cardiac arrhythmia (irregular heartbeat or "A-fib") or atrial flutter. The heart is supposed to be a finely tuned device and any hiccups in this "metronome of life" should be investigated.

  • Changes in hormones, especially in cases of pregnancy or menopause

  • Dehydration

  • Fluctuations in electrolyte levels

  • Hyperthyroidism. This specific issue can be handled with heart-rate-slowing medications.

  • Low blood pressure

  • Low blood sugar levels

  • Old age. People become more prone to palpitations through a combination of natural aging and requiring more medications to remain fully functional.

  • Premature atrial complexes (PACs)

  • Premature ventricular complexes (PVCs)

  • Supraventricular tachycardia (SVT)

  • Strong emotions, especially stress, anxiety and/or depression.

  • Tachycardia, a condition where the heart beats in excess of 100 BPM.

  • Taking medications that feature pseudoephedrine

  • Taking stimulants, be they caffeine, narcotics or nicotine

Heart Palpitations and Anxiety

There are times when heart palpitations have nothing directly to do with a patient's heart and everything to do with a severe anxiety disorder. Dealing with anxiety-induced palpitations may require seeing a psychiatrist for anti-anxiety medications. Even if stress disorders are known to trouble a patient, all patients should be investigated by a cardiologist just to ensure that there is nothing wrong with the heart and some patients would prefer to know that their issues are definitely not related to an impaired heart.

The moment when you experience palpitations that are worryingly severe or last for several minutes are serious red flags that can signal a major cardiac issue in your system.

When Are Heart Palpitations an Emergency and When to Dial 911

You should dial emergency services if your palpitations last several minutes, develop new symptoms, known symptoms worsen or if you notice them during the same time as these symptoms.

  • Sensations of pain, pressure or tightness around the chest

  • Aches along the neck, jaw, upper back and/or arms

  • Shortness of breath

  • Unusual bouts of sweating

  • Feeling dizzy or lightheaded

  • Anything that does not go away after performing breathing exercises

  • Fainting or loss of consciousness

Getting to the Hospital

It can always be risky to drive yourself to a hospital. Remember to focus on your ABCDs:

  • Airway. Is the airway cleared?

  • Breathing. Can the person breathe?

  • Circulation. Is the person's system able to circulate oxygen and carbon dioxide?

  • Disability. Does the person have a relevant disability?

All of these letters may have a role to play in a coronary or other severe emergency. You may believe that you can handle the drive on your own, either because you do not want to panic or you are concerned about an ambulance bill. The best solution is to ask someone nearby to either drive you themselves or have them call for an ambulance when you are experiencing heart palpitations. The ambulance's EMTs are trained to manage your vitals while you are in transit to the hospital and may be a lifesaver if a major complication arises en route.

What To Anticipate at the Hospital with Heart Palpitations

Managing stress levels is crucial to dealing with heart palpitations in the ER. The first thing to expect will be a physical examination, possibly also coupled with other tests to discern the underlying cause of whatever troubles you. These tests can include the following:

  • Electrocardiogram (EKG/ECG). This observes the electrical activity within your heartbeat.

  • Holter monitor/event recording. This is a device worn over the span of one to three days that provides ongoing EKG analysis. A Holter monitor provides a continuous flow of data while event recording requires the push of a button to start and stop analysis.

  • Echocardiogram. This test uses echolocation to analyze movement around and within your heart.

  • Stress testing. This analyzes your heart activity while active, noting pulse breathing and blood pressure statistics as you perform a stationary exercise like traversing a treadmill or cycling within an exercise bike.

  • X-ray. EM radiation is used to photograph your heart.

  • Ultrasound/sonogram. Sound waves are used to photograph your heart.

Testing of the blood and urine may also be done in order to discern if thyroid issues are involved in your problems.

Once your medical team has all of the necessary data, you will be given suggestions on how to handle your symptoms and told to monitor any changes. It is not uncommon for follow up appointments to be scheduled within the next month or two following initial tests. The most extreme form of treatment for abnormal heart rhythm would be cardioversion; while this procedure is only undertaken when medications fail to produce positive results, it involves shocking the heart, while the patient is sedated, so that the heart can reboot and go back to a normal, steady rhythm. Cardioversion patients are sedated so that they cannot feel the electrical shock that goes through the heart.

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The content on this page is for informational and educational purposes only and does not constitute professional medical advice. Patients should not use the information presented on this page for diagnosing a health-related issue or disease. Before taking any medication or supplements, patients should always consult a physician or qualified healthcare professional for medical advice or information about whether a drug is safe, appropriate or effective.