Elderly happy coupleWhen should you be concerned about an irregular heartbeat? Palpitations are an unpleasant awareness of the forceful or rapid beating of the heart. They are often described as pounding, jumping, racing or irregularity of the heart beat, a “flip flopping” or “rapid fluttering” in the chest or pounding in the neck. They can be brought about by a variety of disorders that involve changes in cardiac rhythm or rate. Many people experience palpitations or irregular heartbeats at some point in their life.  There are several associated symptoms that can help differentiate between a serious heart rhythm problem and benign heart palpitations.


“Clues” to help determine the possible cause of the palpitations

An isolated “jump” or skip” usually indicates a premature beat which the majority of the time represent a benign condition.  Palpitations may occur in conjunction with certain foods or medications including tobacco, coffee, tea, alcohol, ephedrine (found in many over the counter cold remedies), thyroid extract (found in some herbal preparations/supplements), thyroid medications, weight loss meds/ upplements, medications for adhd and narcolepsy, and other medications.  If palpitations occur on standing they may be related to postural hypotension. Middle aged women, in conjunction with hot flashes and sweats, the culprit may be  menopause. When you feel palpitations but rate is normal and rhythm is regular, anxiety may be the cause

Palpitations during normal strenuous physical activity is normal.  If palpitations occur during mild exertion the majority of the time it is because the individual is deconditioned or may suggest anemia, overactive thyroid, atrial fibrillation or heart failure.   If palpitations can be relieved suddenly by vagal maneuvers such as coughing, bearing down, stooping, breath holding it suggests heart arrhythmia.  If palpitations are followed by angina then cardiac ischemia needs to be ruled out.  Palpitations are frequently caused by anxiety, panic reactions or emotionally startling experiences.

What are some of the symptoms that should prompt a visit to the cardiologist?

Fainting. There are several different types of fainting.

Postural faints. When stand up become dizzy or lightheaded and pass out. Usually related to medications or dehydration. Example “I jumped up to grab the phone and fell out” or ” I got up from the chair and had to steady myself against the wall”.

Benign fainting episodes.  Episodes tends to come on gradually with fading out sensation and your body going sweaty or clammy and then passing out. Usually not related to cardiac arrhythmias. Example “I felt lightheaded and warm and felt like I needed to sit down”

Malignant fainting episodes. Sudden fainting spell that occurs without any warning symptoms tend to be related to cardiac arrhythmia.  Example “I was standing talking to my friend and then next thing I know I wake up on the floor”

f you have experienced a sudden fainting spell or more than one episode of ordinary fainting spells you need to see your doctor to be evaluated for underlying medical problems.

Cardiac Arrest. The most serious heart rhythm problems can cause sudden cardiac arrest, which require CPR or shock from defibrillator.  Approximately 95% of people who have sudden cardiac death do not make it to the hospital.  90-95% of these types of events occur in people with underlying structural heart disease like a scar from a previous heart attack.  Anyone who survives such an event needs to be evaluated by a cardiac specialist.

There are several lifestyle practices that can worsen palpitations such as consuming caffeinated beverages (coffee, tea, soft drinks, and chocolate), alcohol, stress, and not getting enough sleep.  Changing any or all of these lifestyle practices can lessen or eliminate palpitations.  There are also several medical conditions that can cause rhythm problems such as fever, pain, anxiety, sleep apnea or endocrine problems (especially thyroid abnormalities).  It is essential to treat underlying medical conditions as part of therapy for heart rhythm problems.

If you are having irregular heartbeats it is important to see a doctor for a proper diagnosis – since heart rhythm problems can range from benign premature beats to atrial fibrillation, which can cause stroke, or ventricular arrhythmias which can cause sudden cardiac death.


image shows Eastern Cardiology office in Greenville NC

Office information:

Park Place Professional Center

2090 W Arlington Blvd, Suite B

Greenville, NC 27834

Ph: 252-757-3333 / 252-758-3000

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