Usually, heart palpitations are no cause for concern—but in the presence of these other symptoms and scenarios, they signal serious trouble.
What are heart palpitations?
That odd sensation in the middle of your chest can be alarming, but often it’s just a misfire in your heart rhythm. A series of electrical impulses keep your heart pumping; when one of the impulses is mistimed, you’ll feel palpitations in your chest. Most of the time it’s nothing, but they can be a sign of something dangerous.
There are numerous types of heart rhythm disorders, says Denice Hodgson-Zingman, MD, a cardiologist and associate professor of internal medicine with University of Iowa Health Care. “Some of them make the heart beat irregularly, and this can be perceived as a sensation of ‘flip-flops,’” she says.
Symptoms to watch for
If those electrical impulses fire in the wrong order, you can have the sensation of neck fullness and heart pounding, says Dr. Hodgson-Zingman. “Other rhythm disorders consist of intermittent single extra beats or runs of beats. Because these extra beats are too fast to allow the heart to pump blood efficiently, it can feel as if your heart is skipping beats.” According to Joe Lau, MD, PhD, a cardiologist at Northwell Health and an American Heart Association expert, palpitations may also feel like a fluttering or racing sensation.
“Palpitations are a symptom, so there’s no way to generally define what they feel like because, like all symptoms, the way that it feels varies from one patient to another,” says Emily Zeitler, MD, an electrophysiologist (or heart rhythm doctor) at Dartmouth-Hitchcock Medical Center and a former member of the American College of Cardiology’s Electrophysiology Council. She says palpitations require a diagnostic evaluation by your doctor.
Sign: You often have palpitations
“Depending on the exact causes, some patients may have symptoms infrequently, while others may have several continuous episodes a day, sometimes with each episode lasting for several minutes at a time,” Dr. Lau says. Chances are, if palpitations are only occurring rarely, you don’t need to rush to the doctor. Less serious causes for palpitations can include stress, anxiety, caffeine, alcohol, illness, or pregnancy, he says.
Sign: You have chest pain
Go right to the emergency room (or call an ambulance) if you get chest pain with palpitations, warns Dr. Zeitler. This is a classic sign that your heart’s in serious trouble.
Sign: You’re having trouble catching your breath
In fact, you probably shouldn’t even wait for a doctor’s appointment if you’re experiencing this, as you may be having a cardiac event. When experiencing palpitations, “if you feel like you might pass out or you actually do pass out then you probably need to be seen right away in an urgent care or an emergency department,” she says.
Sign: You passed out
While most people would know something’s wrong with fainting, if your loss of consciousness is preceded by or followed by palpitations, you have even more reason to get medical attention stat, warns Dr. Zeitler. This could indicate some sort of cardiac event, she says. Dr. Lau says dizziness and leg swelling with palpitations can also signal serious heart trouble.
Sign: You have stroke symptoms
“Any stroke-like symptoms such as asymmetric weakness, facial droop, confusion, word-finding difficulty, or visual changes, would be worrisome,” Dr. Hodgson-Zingman says.
Sign: You can’t get through your day
Even if you’re not having very scary symptoms, if you just feel generally terrible or need to stay in bed due to the weird sensations in your chest, you could benefit from treatment, says Dr. Zeitler. Although the cause itself may be benign, it needs to be addressed so that you can function. “Atrial fibrillation [AFib], a very frequent cause of palpitations, comes from the top chamber of the heart, the atrium, and it causes the bottom chamber of the heart to squeeze in an irregular way; the heart rhythm is chaotic,” Dr. Zeitler says. “You don’t have to treat AFib, but doctors often do because it makes people feel really bad and we can make people feel better with medications or with procedures such as ablation.”
Sign: You’ve had palpitations for a long time
Another reason palpitations can be dangerous is that they can weaken the heart muscle. “Heart rhythm abnormalities, if they remain untreated and persist for weeks to months, can result in the heart muscle becoming weak, which is called cardiomyopathy,” Dr. Hodgson-Zingman says. “Fortunately, this form of cardiomyopathy is often completely reversible once the heart rhythm disorder is corrected.” In addition, even less dangerous conditions like AFib can have long-term consequences. “This rhythm is not fatal, but it is associated with a much higher risk of stroke and can cause cardiomyopathy if not recognized and treated,” she says.
Sign: Your heart starts beating really fast
Normally, you won’t even notice your heartbeat—but if you do and it’s speeding up, it could mean your blood pressure is dropping. “When blood pressure is low, the heart compensates by beating faster and harder, and that can feel like a pounding or racing heart,” says Dr. Hodgson-Zingman. If it’s temporary, it could stem from being startled or experiencing strong emotions. However, see your primary care doctor if it keeps happening.
Sign: You already have heart problems
If you already have a heart condition, any rhythm problems can be more serious. “A person with a weakened heart, or cardiomyopathy, may also be predisposed to have extra ventricular beats [from the bottom chambers of the heart],” explains Dr. Lau. “When these heartbeats become frequent and fast, they are termed ‘ventricular tachycardia, and in a weakened heart that may lead to cardiac arrest.”
Sign: You’ve had a heart attack
Heart muscle damaged from a heart attack will have scarring, and that can also predispose you to the extra contractions of ventricular tachycardia, he says. Dr. Zeitler says such patients should be treated immediately. “I would be more aggressive in making a diagnosis and treating with either medications, procedures, or with an implantable defibrillator,” she says. Dr. Hodgson-Zingman says heart disease patients should be evaluated and monitored for rhythm abnormalities regularly.
Sign: You have other health issues
Besides prior heart disease, other health conditions could make palpitations more dangerous—and even though common heart rhythm problems like atrial fibrillation are generally not serious, in some people they can be. “If the patient has other risk factors such as diabetes, high blood pressure, and vascular conditions, their risk of stroke may be high because atrial fibrillation may lead to the formation of blood clots within the heart that can travel to the brain and cause a stroke,” Dr. Lau says. If you have other health issues, alert your doctor if you’re having palpitations.
Sign: You’re getting older
Like many conditions, palpitations may be more common, and more serious, in older people. “Another common problem that occurs with age is the wearing out of the normal heart electrical system,” Dr. Hodgson-Zingman says. “This can cause pauses or irregularity in the heart rhythm and may be a sign that you need a pacemaker.” Also, some types of heart rhythm disorders are more common as you age. “Atrial fibrillation occurs in like 20 percent of people over the age of 80, and it’s increasingly common as we get older,” Dr. Zeitler says. According to the CDC, 9 percent of people over 65 have it.
Sign: You have a family history of sudden death
Regardless of your age, if you have a family history of sudden death before age 50—or a family member with cardiomyopathy—you should pay close attention to any heart palpitations, Dr. Hodgson-Zingman says. Talk to your doctor about your symptoms and your family history.
Sign: Another condition is triggering the trouble
It’s possible that your palpitations are not directly related to your heart. With anemia, “the heart has to work extra hard to pump blood to increase cardiac output so that the body tissues can get enough blood, and therefore oxygen,” Dr. Lau says. Or with overactive thyroid, for example: “Thyroid hormone can overstimulate the heart and make it beat faster,” he says. A blood workup can help identify these problems when you see your doctor about your palpitations.
Sign: Your fitness tracker detects an issue
Use technology to your advantage—your doctor will likely even commend your Apple Watch for detecting an irregular heart rhythm. “Some of those commercially available tools are really good and have been validated scientifically for being accurate at detecting heart rhythm disorders,” Dr. Zeitler says. “If somebody comes to me with palpitations and a tracing from their iWatch that is suggestive of a heart rhythm disorder, it’s pretty likely that I’m going to be doing a diagnostic workup.”
Sign: You feel like something’s not right
Dr. Zeitler advises following your intuition—if you feel like your heart is beating strangely, it’s best to get it checked out. “It’s one of those situations where you have to listen to your body,” she says. “If it feels like you’re dying or you might die, or you pass out or you have an accident because you’re passing out, those are reasons to seek attention in an emergency room. Otherwise, you can generally wait to see your primary care doctor, which would be a really good first step. Your primary care doctor can decide when the right time is to refer you to a cardiologist or a heart rhythm specialist.”