Most of the time we do not feel the beating of the heart although it is an ongoing process throughout life. With the normal heart rate ranging between 60 to 80 beats per minute, it is only on a few occasions that we may be able to perceive this and only for a few minutes at most. However, some people may be able to perceive their heart beat, especially as a pounding, racing or fluttering sensation. This is known as palpitations.
Palpitations can be a symptom of several diseases and not all of these diseases may be a problem with the heart itself. However, palpitations also occur during periods of physical, mental and emotion stress or strain even without any underlying disease. It is therefore important to differentiate palpitations that arise due to diseases (pathologic causes) from palpitations due to temporary increased demands on the body (physiologic causes).
Read more on palpitations.
What Causes Heart Palpitations?
Palpitations are a symptom of abnormal heart activity Any factor that increases heart activity can cause palpitations. This includes increasing the rate of the heart beat or the force of the heart when it is pumping blood. Both alterations in heart activity may arise for several reasons in a host of conditions. While palpitations are not always serious, it should not be ignored.
It is always advisable to seek medical attention when palpitations arise and persist. Similarly if there are repeated episodes of palpitations then medical advice is necessary. Emergency medical attention is immediately required if palpitations are accompanied by other symptoms like shortness of breath, dizziness or loss of consciousness.
There are several heart problems that can present with palpitations. Arrhythmias are a group of disorders where the heartbeat is irregular. Atrial fibrillation, supraventricular tachycardia and ventricular tachycardia are three types of arrhythmias where palpitations are common.
Another type of heart problem where palpitations may occur is premature ventricular contractions. This is sometimes referred to as an extra heartbeat when the ventricles contract sooner than normal. Often this is not serious but it can trigger an arrhythmia.
People who have pre-existing heart disease, previous heart attack or heart surgery are often at greater risk of arrhythmias and palpitations.
Certain hormones can increase heart activity and lead to palpitations. The stress hormones, adrenaline or cortisol, are two such hormones. These hormones are released for several reasons but there is increased secretion during times of stres, which is known as the fight or flight response.
Other hormones may also be responsible for palpitations, namely the thyroid hormones. This is often seen in conditions like hyperthyroidism, where there are high levels of thyroid hormones in the bloodstream. In this case, it is a result of an overactive thyroid gland.
Alterations in the female sex hormones which occurs with pregnancy, menopause and for some women even during the course of their menstrual cycle can lead to palpitations.
Any intense emotion can cause palpitations. Anxiety, fear or shock are common triggers of palpitations and it can persist as long as these emotions are ongoing. This is common for any person. These emotions cause the release of stress hormones like norepinephrine which can increase heart activity.
It is not uncommon for some people to mistaken these palpitations for a heart attack during these stressful periods. However, people with underlying heart diseases like coronary artery disease (CAD) are at risk of having a heart attack during with sudden psychological stress.
Read more on psychological stress.
Strenuous physical activity can also cause palpitations. When exercising the body needs more oxygen. The heart has to increase its activity to cope with the demands of the body. As a result the heart beats harder and faster. Depending on the intensity of the physical activity this may be perceived as a pounding of the heart.
Palpitations in this case is normal and may vary from person to person. However, physical strain can also increase the risk of heart attacks, similar to psychological stress. Any person with underlying heart disease is at risk during periods of intense physical activity.
A host of stimulants can increase heart activity. Caffeine and nicotine are two commonly consumed stimulants as coffee and tobacco are widely used in most parts of the world. However, even caffeine in tea and nicotine in patches or chewing gum may also be a problem.
These substances stimulate the nerves that regulate heart rate and contraction. It can also lead to palpitations, depending on the type of stimulant consumed, quantity and individual sensitivity. People with heart disease may be more prone to palpitations when using stimulants.
Alcohol and Illicit Substances
Alcohol consumption can also lead to palpitations but this depends on the quantity of alcohol that is consumed as well as individual tolerance. It can strain the cardiovascular system and cause irregular heartbeat. Excessive alcohol intake is more likely to cause palpitations.
Various illicit substances may also cause palpitations due to its stimulant action. This includes a host of street drugs like cocaine, ecstasy, heroin and methamphetamines. It causes increases nerve activity, release of hormones that stimulate the heart and may also elicit intense emotions that further contribute to palpitations.
There are several over-the-counter (OTC) and prescription drugs that may cause palpitations as a side effect. Certain cough and cold as well as weight loss drugs are widely known to cause palpitations. However, it can also occur with various other drugs including some types of antibiotics, asthma inhalers, hypertension medication and thyroid drugs.
Palpitations as a side effect may also occur with certain antibiotics, antifungal drugs and antipsychotics. Another possible iatrogenic cause of palpitations may be linked to synthetic thyroid hormones. These drugs are used for an underactive thyroid (hypothyroidism) but can cause palpitations if taken in higher than required doses.
Palpitations may also be a symptom of other conditions. This may be seen when the blood glucose levels drop too low (hypoglycemia). Palpitations may also arise with a fever. This is more likely to occur with a high fever, especially if it is persisting for a long period of time. Pain can also trigger palpitations as the stress hormones are released which may then increase heart activity.