Heart palpitations - is this just election-related anxiety?
Any one else having heart palpitations right now? It’s quite common during super stressful times (hello nail-biting election) to be having some heart palpitations or extra heart beat sensations. This is probably one of the more common symptoms I hear from patients, and typically their first question to me is - are my heart palpitations just anxiety or are they due to something else? Could they be dangerous? Let’s break it down.
What are palpitations
Heart palpitations are the sensation of feeling your heart beat in your chest. They are often described to me as
heart fluttering
heart racing
heart pounding
skipping beats
flip flopping
feeling like the heart is stopping and starting
They can be felt in the chest or the neck or both.
All of these can be normal or they can be abnormal. Why? Because the heart receives input from our autonomic nervous system. The sympathetic nervous system, or “flight or flight,” increases our heart rate and blood pressure. Back in our caveman days, this helped us to escape getting eaten by the tiger. The parasympathetic nervous system, or “rest and digest,” decreases our heart rate and blood pressure. Thus, things like stress, medications, exercise, and things we eat and drink can have profound impacts on our heart rate (how fast our heart is beating), and sometimes, our heart rhythm (which is where the electrical impulse is coming from to tell our heart to beat). In this case, a heart palpitation isn’t a sign of anything wrong or dangerous, just our heart responding to external inputs.
What is an arrhythmia
Arrhythmia is a catch-all term for an abnormal heart rhythm.
Arrhythmias can take many forms and range from benign (not serious) to life threatening. As a cardiologist, one of the most common heart arrhythmias I see are premature atrial contractions or premature ventricular contractions, which are extra heart beats coming from top part of the heart or the bottom part of the heart, respectively. These extra heart beats are rarely serious, particularly when they occur in people without heart disease. Almost everyone has them every now and then, and many people don’t even feel them.
Others can be more serious. The most common heart arrhythmia is atrial fibrillation, which is a disorganized heart rhythm coming from the top part of the heart that can lead to stroke. Other common heart rhythm issues include slow heart rhythms (bradyarrhythmia) like heart block as well as other fast heart rhythms (tachyarrhythmia) like supraventricular tachycardia and ventricular tachycardia. The more serious heart rhythm problems are much more common in people who have other medical problems like high blood pressure, obesity, obstructive sleep apnea, heart disease (either prior heart attacks or heart failure), as well as old age.
What causes palpitations
Heart palpitations can be brought on by many external factors. The most common are
stress, anxiety, anger, or other emotional upset
too much caffeine
too much alcohol
smoking
medications (like cough medicine, asthma medicine, or stimulants)
vigorous exercise
hormone changes (many of my female patients have them with every menstrual cycle; also common in pregnancy and menopause)
dehydration
They can also occur in the setting of a medical problem such as thyroid issues or anemia, which can be detected by a blood test. They are also quite common with fever or infection.
So how do I know if my palpitations are dangerous or not?
As with all medical problems, you should absolutely seek medical advice from your personal physician. However, it can be reassuring to know that, particularly in the absence of heart disease or other chronic medical problems that put you at higher risk, heart palpitations are typically not dangerous or sign of a heart rhythm problem.
Signs that heart palpitations is unlikely to be dangerous are if they are infrequent and fleeting.
On the other hand, signs they might be more dangerous are if they are associated with chest pain, passing out, shortness of breath, or dizziness. Other warning signs include frequent symptoms or worsening symptoms. You should also be sure to see a doctor if you have known heart disease or risk factors for heart disease, simply because the risk of arrhythmia increases under these circumstances.
To be on the safe side, a visit to your doctor is always prudent, particularly if the palpitations persist. If warranted, they will likely do some basic bloodwork to rule out an underlying medical problem, as well as potentially some heart testing (such as an EKG, echocardiogram, and heart monitor).
Treatment for palpitations
Often times, if symptoms are infrequent and don’t particularly bother my patients, once I have done some basic testing and reassured them that their palpitations are not dangerous, no further treatment is indicated. For other patients, the symptoms are quite bothersome and so we try different lifestyle changes to attempt to improve their symptoms. Things I try with my patients include
elimination or reduction of caffeine (for some, this even has to include chocolate 😢)
elimination or reduction of alcohol
stress reduction techniques including mindfulness, yoga, meditation, gratitude journaling, nature therapy, and box breathing. If the election is stressing you out, take a break from the news.
palpitation diary (yes, I know this sounds like straight out of the Babysitters Club, but it can be very effective - keeping a detailed diary of symptoms in conjunction with food, drink, and mood can be super helpful to identify the culprit)
discussing medication adjustment with the prescribing doctor
hydration
focus on sleep, including making sure you are getting enough and ruling out sleep-related issues, like obstructive sleep apnea
Here’s to hoping for a less stressful 2021
