Reasons your heart just skipped a beat—and when to worry

Has your heart ever felt like it was fluttering, throbbing, pounding, or skipping a beat? That feeling is called a heart palpitation.

Generally, heart palpitations aren’t life threatening, says Tanmay Swadia, MD, a cardiologist in Livonia, Michigan. Infrequent palpitations and palpitations only lasting a few seconds usually don't need further evaluation. But there are instances where a dysrhythmia, or an abnormal heartbeat, can be a cause for concern. Here are ways to tell if your heartbeat is normal, or not.

What your heartbeat says about your heart

Palpitations are basically a heightened awareness of your own heartbeat, explains Dr. Swadia. Your heart might beat faster, slower, or differently than usual for a few reasons. These include:

• Rapid, fast heartbeat at rest could be caused by stress, caffeine, alcohol, tobacco, certain cold medications, asthma drugs, or diet pills. Sometimes low blood pressure, heart disease, and some heart rhythm conditions can cause rapid heartbeat, too.
• A slow, forceful heartbeat might be a sign of heart rhythm problems such as bradycardia, in which your heart beats less than 60 times a minute.
• An irregular or fluttering heartbeat could be caused by atrial fibrillation (AFib), the most common type of irregular or abnormal heartbeat. Another heart problem, called premature ventricular contractions, can create this irregular beat.

It might be difficult for patients to describe how exactly their heart is feeling. And likewise, healthcare providers (HCPs) sometimes have a hard time understanding what the patient is feeling.

“I have patients describe their heartbeat by tapping their finger on the table and just tell me how it feels to them,” says Swadia. This helps him take a first step toward diagnosing the issue.

What’s normal and not-so-normal

The good news: While uncomfortable at first, heart palpitations are mostly benign. Heart flutters can occur frequently or infrequently, says Swadia.

“Generally, the frequency of heart palpitations does not dictate if the palpitations are serious or benign,” he says. The symptoms that accompany the palpitations usually signal whether it’s a medical emergency or not.

You should seek immediate medical attention if you have any of the following symptoms:

• Dizziness
• Lightheadedness
• Chest pain
• Shortness of breath
• Fainting

Palpitations can be a sign of a heart problem. This is more likely in men or people with heart disease. If your palpitations are frequent, worsening, or lasting more than five minutes, speak with your HCP about your symptoms.

Anxiety, stimulants, and your sex may also affect your heartbeat

Some groups of people are at higher risk than others for heart palpitations. People who are menstruating, perimenopausal, or pregnant may have a higher risk of experiencing heart palpations because of hormonal changes.

Other groups at people at higher risk include those who:

• Experience regular panic or anxiety attacks.
• Take medications like thyroid pills or stimulants like caffeine and diet pills. (That said, if thyroid pills are properly dosed, they should not present a problem.)
• Have an existing medical condition such as an overactive thyroid or a heart condition.

What to expect during a visit to your healthcare provider

If you go to see an HCP for heart palpitations, expect them to do a thorough medical history and exam.

“Getting the patient’s story and performing an in-depth physical exam is very important in figuring out if a patient needs further evaluation,” says Swadia. The exam will typically include listening to the patient’s lungs and evaluating their heartbeat and pulse.

HCPs also typically use an electrocardiogram (ECG or EKG), which assesses the electrical conduction of the heart. Even if the EKG comes back normal, it doesn’t rule out an arrhythmia or heart rhythm problem.

Your HCP might recommend something called an ambulatory monitor. These include holter monitors, which are worn for 24 to 72 hours. Another device, called an event recorder, is worn for two to four weeks. The pocket-sized device can check for an abnormal heart rhythm when you notice symptoms.

If the underlying cause of your heart palpitation turns out to be a more serious heart condition, your HCP may do a more comprehensive evaluation.

Ways to lower your risk of heart palpitations

“I cannot emphasize enough how much lifestyle measures go a long way,” says Swadia.

Try to cut out any known triggers such as smoking, heavy alcohol use, caffeine, and energy drinks. “A lot of young people tend to overuse some of the energy drinks, which is one of the leading causes of palpitations.”

Pencil in some time for self-care to reduce stress levels and lower your chances of palpitations in the process. Aim to drink six to eight glasses of water a day and get seven to nine hours of sleep a night, too.

Next time you have heart palpitations, try this

If you feel your heart pounding, use these strategies:

• Relax. Lower your stress levels by using relaxation techniques like yoga, meditation, and deep breathing. These techniques can help bring your heart rate back to normal.
• Reach for some water. Dehydration can cause heart palpitations, so if your heart flutters, make time to drink some H20.
• Work out. Exercise keeps your heart healthy and increases your heart rate, which can prevent palpitations. Try a brisk walk around your neighborhood.
• Cough. Vagal maneuvers are simple techniques that can help slow heart rate. Examples include coughing in a certain way, placing an ice pack on your face, and bearing down (as if you were having a bowel movement) while holding your breath. These can stimulate the vagus nerve, which helps regulate heart rate. Talk to your HCP for tips before performing vagal maneuvers at home.

"While heart palpitations often cause a lot of discomfort to the patient, most of the time they aren’t dangerous," says Swadia. If you can perform those at-home tips to temporarily relieve discomfort, you can always decide if you want to see an HCP for a follow-up consultation.