Heart Palpitations: What Is It and What Are the Causes?

Our heart rate is automatically controlled by the autonomic nervous system (ANS) that has two divisions: sympathetic and parasympathetic. The part of the ANS that is responsible for raising a person’s heart rate through the sympathetic plexus is the sympathetic division. The parasympathetic division, on the other hand, lowers one’s heart rate through the vagus nerve.

What are heart palpitations?

A heart palpitation is the unexpected awareness of the heart beating in the chest. Normally, we do not feel our heart beating, but when you have palpitations, you suddenly notice your beating heart. People who have heart palpitations usually experience rapid, forceful, or irregular cardiac impulses. They describe this experience as thumping, pounding, fluttering, jumping, racing, or skipping feeling in the chest.

Although this experience may be extremely frightful, it is usually harmless and does not always indicate an underlying heart problem. For instance, every one of us has had heart palpitations in our life. Remember the feeling of your heart pounding after a long run or while you are waiting for an interview or examination? That feeling of your heart pounding or racing is a heart palpitation. Such experiences are normal and everyone gets to experience it. That is why palpitations are not always a sign of an underlying heart condition.

Heart palpitations also occur in people with an abnormal cardiac rhythm such as arrhythmias. However, it is important to know that not everyone with sustained arrhythmias experiences heart palpitations. For example, atrial fibrillation (AFib) is a well-known common cause of irregular heartbeats in elderly people, but it rarely causes heart palpitations.

Can heart palpitations occur in healthy individuals?

Yes, of course. Healthy people are occasionally aware of their heart beating. Heart palpitations are often due to physical or psychological stress. For example, you may have felt your heart racing or pounding after exercise or when you are anxious about something like an interview or an exam. Heart palpitations are more common to occur at night when everything is quiet, dark, and there are no disturbances. During this time, your heart beating sensations become more prominent.

Thin people may feel palpitations when they lie to their left side. Palpitations can also be brought about by excessive caffeine intake and by nicotine in cigarette smoking. Therefore, heart palpitations can be experienced by anyone of us, and unless there are other associated warning signs, it is not a sign of something dangerous.

What are the causes of heart palpitations?

Heart palpitations can arise due to several causes and some of them are explained below:

1. Extrasystoles or Ectopic Beats

Extrasystoles can arise from either the atria or the ventricles. They are a benign cause of palpitations, which occur at rest but tend to disappear when exercising. People with this condition often describe their palpitations as if their heart "skips a beat," which is sometimes followed by a strong heartbeat. Other people also describe these palpitations as “heart jumps” or “flutters.”

When there is an ectopic beat, there is a smaller stroke volume because of an incomplete left ventricular filling. Therefore, an impalpable pulse is produced. This pulse leads to the subsequent overfilling of ventricles, eventually resulting in a forceful contraction with the next beat.

2. Atrial or Ventricular Tachycardia

Atrial or ventricular tachycardia is a pathological rapid heartbeat. They often start suddenly and last for a few minutes to hours. They are not triggered by anxiety or stress.

There are three types of tachycardias that are classified according to their location and type of heartbeat. They are:

• Supraventricular tachycardia – As the name represents, the rapid heartbeats are produced in a position above the ventricles. People with supraventricular tachycardia usually describe their experience of heart palpitations as "racing" or "fluttering." This condition is sometimes associated with polyuria.

• Atrial fibrillation – is a very common arrhythmia that may result in a rapid and erratic heartbeat. Patients with atrial fibrillation may describe their heart palpitations as “jumping about” or “racing.” This condition is often associated with breathlessness that sometimes may go unnoticed.

• Ventricular tachycardia – is a rapid heartbeat that originates from the ventricles. Patients with ventricular tachycardia may experience their heart palpitations as "racing" or "fluttering." It is often associated with breathlessness and may present with syncope rather than as palpitations.

3. Endocrine Causes

• Pheochromocytoma – is a small epinephrine and norepinephrine-secreting tumor of the adrenal medulla, which results in episodes of high blood pressure, palpitations, and headache.

• Thyrotoxicosis or Hyperthyroidism – is a condition wherein thyroxine levels in the body are raised due to the overactivity of the thyroid gland.

• Hypoglycemia – is a state of reduced blood sugar. It is a common situation encountered by most people with uncontrolled diabetes.

 4. High Output Cardiac Failure

Anemia, pyrexia, and heart conditions such as aortic regurgitation and patent ductus arteriosus are high output cardiac states that cause your heart to beat more forcefully and rapidly to supply the body its desired amount of blood.

5. Drugs

Drugs such as atropine and adrenaline can bring about heart palpitations. Beverages containing caffeine such as coffee and tea as well as alcohol can also cause heart palpitations.

6. Psychogenic

Psychogenic states such as prolonged anxiety can also make you suddenly aware of your heart beating inside your chest.

7. Idiopathic

Sometimes, no matter how much you investigate, the exact cause cannot be found for your heart palpitations. For these cases, they are classified as idiopathic.

8. Lifestyle Triggers

Palpitations, as explained before, can be brought about by drinking beverages that contain caffeine, eating spicy foods, consuming alcohol, smoking, and using recreational drugs. States of anxiety, anger, or nervousness also trigger heart palpitations. In all of these situations, the body releases a surge of adrenaline, which is responsible for heart palpitations. Adrenaline is a hormone in the body that is released when people overexert themselves or in response to states of anxiety, anxiousness, or nervousness.

9. Pregnancy, Menstrual Cycles, and Menopause

Palpitations also occur in some females during their monthly periods, while pregnant, or at their menopausal stage. Heart palpitations occur as a result of the changes in their hormones. However, palpitations in these conditions are only temporary and should not be a factor to worry about when experienced in such situations.

If you are experiencing episodes of heart palpitations, then you should consult your doctor to clarify your heart rate and rhythm. Consulting a doctor early will help come to an accurate diagnosis.

Tests

The following are some of the tests that can be done to monitor and check a person’s heart rate:

• Electrocardiogram (ECG) - is a diagnostic procedure to determine arrhythmias and their causes. ECG also gives a visual illustration of the electrical currents that are produced on each heartbeat.

• Laboratory tests – include a complete blood count (CBC) and serum electrolytes particularly Magnesium and Calcium determination. For people with arrhythmias, a troponin test will be required.

• Imaging, stress tests, or both – these tests are often required by the doctor in patients who have heart problems or diseases. 

Oftentimes, heart palpitations do not cause symptoms and do not impair the pumping ability of the heart. Although there are some people who get anxious if they become aware of it, you should not worry too much if you’re having such palpitations.