Are Heart Palpitations Dangerous? A Doctor Explains

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Are Heart Palpitations Dangerous? A Doctor Explains

Are heart palpitations dangerous? A doctor explains what happens when your heart seems to skip a beat.

[Editor’s note: This article was originally hosted on, our sister site.
It’s now featured here as part of our new general-health section.]

rabbit-heart-palpitationsby Eva F. Briggs, M.D.

Q. What are heart palpitations? Should I be concerned about them? Also: I don’t understand how my heart can skip a beat and it doesn’t cause any damage! Why doesn’t it?

A. On television and in the movies, the human heartbeat is portrayed as steady as a metronome: lub-dub, lub-dub, lub-dub. But our hearts aren’t mechanical, and sometimes Mother Nature skips a beat, or sneaks one in early. When that happens, you feel the irregularity as a peculiar thump or fluttering sensation: a palpitation.

What Causes Heart Palpitations?

Most palpitations are not dangerous. They’re due to minor system glitches.

Your heart has a built-in pacemaker. Sometimes the atria (upper heart chambers) or ventricles (lower heart chambers) jump in before the pacemaker fires. The result is an early beat, called a premature contraction. The heart often responds by delaying the next scheduled beat.

People may not even notice the early beat, but perceive the interval until the second, delayed beat as a skipped beat. The body is actually maintaining the overall balance and continues to function without any harmful effects on circulation.

One common reason for these premature contractions is epinephrine. Sometimes called the fight-or-flight hormone, epinephrine can increase your heart rate, often causing rapid or early beats felt as palpitations. Your body makes more epinephrine when you’re frightened or stressed. That explains why your heart seems to thump right out of your chest during a scary movie.

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When Are Heart Palpitations Dangerous?

Sometimes palpitations do indicate a heart problem. Warning signs for underlying serious problems include:

  • Continuous palpitations—over six per minute or three in a row.
  • Lightheadedness
  • Shortness of breath
  • Passing out
  • Chest pain

Potential serious causes of heart palpitations include:

  • An overactive thyroid
  • Blockage in the coronary arteries
  • Electrolyte imbalances (sodium, potassium)
  • Diseases of the heart muscle
  • Abnormalities in the heart’s electrical system
  • Malfunction of the natural pacemaker

(The last two can lead to the heart not beating efficiently, potentially weakening it.)

What Are the Tests for Heart Palpitations?

To help find the cause of palpitations, your doctor will likely perform an electrocardiogram (EKG). This simple test records the heart’s electrical activity through electrodes attached to the chest. The tracing provides information not only about the heart’s rhythm, but also about its size, evidence of prior structural damage and possible delays in the electrical signals.

Often, the troublesome palpitations don’t happen while you’re at the doctor’s office. In that case, your doctor may hook you up to a portable monitoring device that records the heart rhythm as you go about your daily routine. Depending on the doctor’s initial findings, he or she may order additional tests such as blood work or an echocardiogram (sound wave picture of the heart).

What Is the Treatment for Heart Palpitations?

If nothing serious is causing the palpitations, the first treatment step is generally lifestyle modification, such as cutting back on caffeine and avoiding decongestants. (These stimulants can exacerbate palpitations.) Also, regular aerobic exercise leads to a slower baseline heart rate that’s less susceptible to palpitations.

Prescription medicines are reserved for the most stubborn cases. The most commonly used drugs, called beta-blockers, act by slowing the heart rate.

Luckily, most people won’t need medicines to treat palpitations that aren’t due to heart disease or illnesses. Sometimes the reassurance that your heart is normal is enough to make the palpitations less scary and therefore less noticeable. Remember that even though it seems as if your heart is going haywire, it’s still pumping all the blood required by your brain and other vital organs.

But if you have any question at all, see your health-care provider to make sure of the cause.

EVA F. BRIGGS, M.D., is a board-certified family physician in Marcellus, N.Y.

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Original version appeared in May/June 2008 issue of My Family Doctor magazine. This general health-care information is not meant as individual advice. Please see our disclaimer.

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  • Jessica Caldwell

    Just had heart palpitations today for the first time in about 2 to 3 months. I was at softball practice and all of a sudden I became light headed and couldn’t see for a second and then my heart started to be fast. It lasted about a half an hour and chest pain started not to long after my heart rate spead up. My heart shook my whole body. My coach benched once he checked my heart rate. He said it was abnormally fast. This has only happened one other time to me, when I was doing basketball. I now know this is recurring thing so I am going to the doctors soon.

    • James Hubbard, MD, MPH

      Yes, it sounds like you should. The sooner the better.

  • Alex

    40 year old male. Hypothyroid…only taking .25 of Levo ( low level). No drugs, drinks a little, two stressful….I mean rambunctious….I mean lively boys, age 3 and 5. Just turned 40 a few months ago and days before that I had my first episode. Thought my throat was twitching or my esophagus was having a spasm….the second day of the “spasms” I checked my pulse at the neck and felt the missing beats. Chills went up my spine, set and appointment at the Dr.s and immediately screened the internet to self diagnose. Dr heard the the PVC’s. ECG was done. Results came back fine. Heart was great…he said. As hard as it still is, I gave up coffee. No soda. Drink a lot of soda water. Not the greatest diet but not altogether bad. That first episode last about 2-3 weeks and then mellowed out. Had a recurrence only one night during a concert, and this last episode I am currently in for 4 days. Slowing down right now, but I noticed I feel them more when sitting down…with a eager adrenalin-like feeling…..kind of been tired as well. In the middle of a move and all that comes with that but I don’t just want to pin it on stress and I hate feeling like a hypochondriac……but I don’t want to keel over at my desk either???

  • matt

    Hi I have been having heart palpitations on and off for about 2 years now and I am really scared I am only 24 years old I’m male no family history of heart disease that I know of, it all started after I had a anxiety attack while eating mind you I had like 3 big cups of coffee when I woke up. It just seems that I have been knocked down by this and very scared that it is something very serious.

    • James Hubbard, MD, MPH

      See a doctor and have them checked out. Meantime try to cut your overall caffeine by a least half, preferably two-thirds and see if the palpitations go away.

  • WR

    Can the hormonal changes of menopause cause heart palps too? Once in a while I get palpitations but it’s sporadic at best. No fast pulse or anything alarming, just a flip/flop once in a while. I don’t do caffeine or anything else that might cause it. My care provider was not alarmed but did not do an EKG. I read somewhere that many women experience heart palps as part of the menopausal transition, but it’s often dismissed as a panic attack and nothing more. What do you think – can heart palps be part of perimenopause?

    • James Hubbard, MD, MPH

      Yes, heart palpitations can be caused from hormone changes but if you have concerns ask your doctor about doing some heart tests or referring you for some.

  • Barbara Chira

    Hi, Dr. Hubbard. I am a 57 year old female, overweight (secondary to early knee arthritis), and have been having palpitations (“flops,” feeling pulse in neck, etc.) for 2+ weeks. It does not seem to recede very much – fairly constant. Resting heart rate has been between 64-82. The extra beats seem to be between 0-6 times per minute; when they happen, I feel a little lightheaded, but it passes within seconds. They seemed to me to begin leading up to a series of dental appointments, the last appointment of which was on Friday. Now this weekend, being home from work, snowed in, and not busy, I have grown more concerned, and wondered if I should go to the ER. I drink 1 cup of coffee per day, no alcohol, and do not smoke. I cut out coffee on Friday. The only daily medication I take is Meloxicam for knees, and Prilosec.

    I had palpitations once before, about 6 years ago; the family doc said they were likely related to what was the recent death of my mom at that time. He did not do an EKG or order any tests. Theu were not at all as troubling as they are now, and they resolved in a few weeks.

    Thank you for any feedback.


    • Barbara Chira

      Also, I have been reading that there is a connection to the vagus nerve, and wondered what you thought of that.

      • James Hubbard, MD, MPH

        Barbara, sounds like you should have the palpitations checked out. Maybe talk to your regular doctor or go to an urgent care, or the emergency room if you deem that best. I’m not sure what you’re asking about the vagus nerve. Yes, it affects the heart, but I’m not sure how it relates to your symptoms. Here’s a post on how how it can slow the heart in certain circumstances but, again, your described symptoms don’t fall into that category.

        • Barbara Chira

          Hi, Dr. Hubbard – I had an appointment with my internal medicine doc this morning. 10-second EKG normal, or at least, no change from previous, 7-8 years ago, when I was age 48-49. Tomorrow I get set up with a 24-hour Holter monitor, and Thursday I have a chemical (non-exercise, due to knee arthritis) stress test. It was a big relief to hear that my EKG had absolutely no changes from 7-8 years ago, a time prior to disabling knee arthritisi, when I was still fit, physically active, and feeling healthy.

          • James Hubbard, MD, MPH

            Great news. I wish you the best.

          • Barbara Chira

            Thank you for your support, information and encouragement. I had never heard of a chemical stress test, and am a little fearful about having it. Would rather have an exercise test, and could manage a stationary bike, but I don’t think they have that equipment. Well, at least the chemical part of the test should be over in < 10 minites, I imagine. Thanks, again.

  • Christian

    I’m 18 and in great shape, but a few years ago I felt a palpitation and since then I’ve been completely conscious of my heart beat, I’ve always been extremely athletic and in shape, but now I have severe anxiety and panic attacks to the point I can literally do nothing. Most of the time I have one to three palps at a time, but sometimes I have more. One time 20 in a row, and today in about 8 waves of 5. I have had an ekg, a stress test, and two echocardiograms that all came back normal. I drink no caffeine . Could the doctors have missed something?

  • denroy

    HI, i am 18 years old and last summer i had a panic attack and continued having them for several months and now after my first go aorund with palps they have gone away but recently while walking im not sure if it my lungs or heart but i find myself gasping quickly then that puts me on edge it used to happen at home but now it happens mostly when i am walking does this seem like something serious? Ive been to the doc alot and did alot of tests and evrything came back fine but i dont feel fine maybe its anxiety but its just scary to deal with because this is all new to me

  • Justin

    When I was 25 years old (I’m 30 now) I would get palpitations every once in awhile, so I went to a cardiologist, and he said the EKG was showing that I had an extra heart beat every once and awhile and to just cut back on caffeine and I should be fine. That seemed to fix the problem until this past year or so. Several times in the middle of working out, my heart starts to flutter violently for about 20-30 seconds. It scares me so bad, I just have to stop what I’m doing and try and walk it off. I plan on going to see my primary as soon as possible, but was wondering if you could offer me any advise. Thank you for your time.

    • montereychic

      Justin, did you ever find out what was going on? I am having the same thing. I also have a history of benign palpitations that had gone away, now this flopping in the middle of exercise!

      • Justin

        Yes, I went to see a Cardiologist. He gave me an EKG and an echocardiogram as well that checks for abnormalities in the structure of the heart (if I remember correctly. Everything looked fine. He said it could be reflux from the fluid that I drinking while working out, and that he used to get them at the gym too. I only had to pay around $60 with my insurance-it’s worth going to check just to be sure…

        • montereychic

          Thanks for the quick reply, Justin! My primary care dr is a cardiologist, so I will call today to get checked out. Funny, I was wondering about reflux. I have been having issues lately with reflux, and when my heart starts flopping around, I can’t feel it skipping at my pulse in neck, which I normally can with normal palpitations. Thanks again!

    • James Hubbard, MD, MPH

      Justin, yes, see your primary care doctor this week. Also think are there any new triggers such as increased anxiety, change in diet, any meds, herbs, supplements, smoking, caffeine.

      • Justin

        Will do, thank you.

  • Dean

    I’m 21 and I’ve been having palpitations (especially last night where my heart would race from time to time) which caused huge concern because I’ve never had them before. Been to the Doctors today and I was told that (Like what most people have said they’re Doctors told them) it’s nothing to worry about. Try to avoid taking things that speed up the rhythm of your heart such as caffeine. Also I was told that exercise can play a role in it, does this mean I should cut down on the amount of exercise I do?

    • James Hubbard, MD, MPH

      Great question. I would think regular, exercise would help. If you think they might have said otherwise, I would call the office and get it clarified by the doctor.

      • Dean

        Okay thank you so much for your advice and your efficiency on replying :)