When heart palpitations signal a more serious problem

Heart palpitations can cause the heart to feel like it’s racing, pounding or fluttering. Typically, these sensations are harmless and temporary — brought on by stress, excitement, exercise or medication. However, palpitations can be a sign of a more serious heart condition such as a heart arrhythmia that might require treatment.

Heart arrhythmias, or irregular heartbeats, occur when the electrical impulses to the heart stray from their normal sequence. This disruption of the heart’s regular rhythm can cause the heart to beat too fast, too slowly or irregularly.

There are many different types of irregular heartbeats. An arrhythmia may be experienced as:

• Heartbeats that are too fast (tachycardia)
• Heartbeats that are too slow (bradycardia)
• Heartbeats that come from abnormal areas of the heart (supraventricular or ventricular arrhythmias)
• Extra heartbeats (premature atrial and ventricular contractions)

The heartbeat is controlled by electrical impulses that begin in the upper chamber (atria) of the heart. The most common type of heart arrhythmia, atrial fibrillation (A-Fib), occurs when these electrical impulses are erratic. This causes an irregular heartbeat that affects the heart's ability to pump blood efficiently to the rest of the body, which can eventually lead to blot clots or stroke.

Heart arrhythmias that cause serious heart palpitations

Most heart arrhythmias, including A-Fib, result from faulty electrical signals in the heart’s upper chambers. Other arrhythmias, such as ventricular tachycardia (VT), involve the heart’s lower chambers or ventricles. Both types of arrhythmias can cause heart palpitations. 

Typically, the heart pumps at a rate of about 60 to 100 beats per minute. A heart rate of more than 100 beats per minute is considered tachycardia. For most people with VT, their heart rate increases to 170 beats or more.

When to worry about heart palpitations

The severity of a heart arrhythmia typically depends on how quickly the heart resumes its normal rhythm. For example, the abnormal electrical signals that cause VT prevent the heart’s chambers from filling completely with blood between beats, which reduces blood flow to the other organs and the rest of the body. When VT only lasts for a few beats, it doesn’t do much harm. However, when this rapid heart rhythm persists for more than 30 seconds, it’s called sustained ventricular tachycardia, which can be deadly and requires immediate medical attention.

What heart palpitations and other signs of heart arrhythmias feel like

A-Fib, VT and other heart arrhythmias may not always cause symptoms, particularly if the episodes are short. However, when an arrhythmia like VT lasts more than a few seconds or when the heart rate is very high, most people will experience heart palpitations or feeling like their heart is racing, fluttering or pounding. It’s a sensation that makes a person take notice of their heartbeat, which can be worrisome.

Additional symptoms of VT include:

• Chest pain
• Dizziness
• Lightheadedness
• Loss of consciousness
• No pulse or a weak pulse
• Shortness of breath

If you are experiencing chest pain, this could be the sign of a heart attack. Call 911 immediately. 

If you think you may have a heart arrhythmia, make an appointment with a physician. They may refer you to an electrophysiologist for further testing. As the state’s largest cardiovascular network, we make it easy for our patients to access a full spectrum of heart, lung and vascular care treatments and services.

If you think you might be at risk of developing a heart condition, take a free heart health risk assessment today to better understand your heart disease risk and the best next steps you can take for your health.

What causes heart palpitations and arrhythmias like VT?

Arrhythmias such as VT typically develop in people with other heart conditions, including:

• A history of heart attack
• Abnormal heart valves
• Blocked arteries
• Coronary artery disease
• Heart failure
• Conditions that cause the heart muscle to become enlarged or weakened, such as cardiomyopathy

However, not everyone with VT has heart disease. Other factors that increase one’s risk of VT include:

• Age
• Family history of heart rhythm disorders
• Personal history of certain genetic conditions, such as Long QT syndrome or Brugada syndrome
• Taking certain medications, such as:
  • Anti-arrhythmic drugs
  • Over-the-counter decongestants
  • Herbal remedies
  • Diet pills that contain a banned substance known as ma huang or ephedrine

Additional factors and activities that can cause heart palpitations and trigger VT include: 

• Exercise
• Heavy caffeine or alcohol consumption
• Electrolyte imbalances, such as low levels of potassium in your blood
• Use of some illegal drugs, such as cocaine and methamphetamine

When to go to the emergency room (ER) for heart palpitations

Heart palpitations that last longer than 30 seconds are considered a medical emergency. Sustained heart palpitations could indicate a pre-existing heart disease such as a heart valve disorder, coronary artery disease or a life-threatening heart arrhythmia. 

Sustained VT, for example, can cause vascular collapse or sudden cardiac death. People with sustained VT may also need IV medication to help restore a normal heart rhythm. 

Untreated, VT can lead to ventricular fibrillation (VFib), which occurs when the heart’s ventricles contract in a rapid and uncoordinated manner and requires immediate emergency care.

If you experience symptoms in your chest alongside heart palpitations, including pain, pressure or tightness, these could be signs of a heart attack. Go to the closet ER as soon as possible. 

How are heart arrhythmias like VT treated?

Primary care providers can provide care for some heart conditions, but if you experience complex issues with heart rhythm, you may be referred to an electrophysiologist — a specialist who focuses on the heart’s electrical system. The goal of heart arrhythmia care is to restore the heart’s normal rhythm and prevent future episodes and cardiac events. 

For example, VT treatments can range from lifestyle changes to cardiac procedures, including:

• Medication
• Cardioversion through medication
• Cardioversion through a medical procedure that provides a relatively low electrical shock to the heart
• Catheter ablation — a procedure that creates tiny scars in the heart tissue that can effectively block the abnormal electrical signals causing the rapid heartbeat
• Device implantation, such as a cardioverter-defibrillator implantation
• Identifying and managing any underlying health issues that may trigger an abnormal heart rhythm

As most people with VT have other heart conditions, VT can be treated by treating other heart issues. For example, coronary artery disease can lead to VT, but if your physician can identify a blockage and treat it, it will improve your heart’s functionality overall. 

How to avoid heart palpitations and prevent VT

Since VT is usually caused by some type of heart damage, the best way to prevent this arrhythmia is by adopting heart-healthy lifestyle adjustments, including:

• Stop smoking. Smoking is a major risk factor for heart disease. Ask your physician for resources to quit smoking for good.
• Know your numbers and keep them in check. Make sure you know your blood pressure and cholesterol levels and take any prescribed medication as directed.
• Manage your diabetes. Make sure you are doing all that you can to keep your blood sugar levels within a normal range, which includes eating a healthy diet, following through on your treatment plan and getting regular exercise.

Other healthy habits that could prevent heart palpitations and VT include:

• Cut back on caffeine. Limit your caffeinated beverage intake to no more than two cups per day.
• Avoid alcohol or drink only in moderation — If you choose to drink in moderation, men are recommended to have no more than two drinks per day and women are recommended to have one.
• Take steps to ease stress. Activities such as physical exercise and deep breathing techniques can help decrease your stress levels and help you relax.

HCA Healthcare's collaboration with the American Heart Association

Knowledge and management of heart-related risk factors and conditions are critical to improving overall health and preventing disease. This is the focus of
the American Heart Association’s Getting to the Heart of Stroke™ initiative, developed in conjunction with HCA Healthcare and the HCA Healthcare Foundation. The initiative includes a new stroke self-management tool, along with an emphasis on greater engagement with patients diagnosed with atrial fibrillation (A-Fib) through the Association’s MyAFibExperience patient support network.