Heart palpitations are a common symptom that can be caused by various health problems. Sometimes, it results from a severe heart condition, such as a heart attack or arrhythmia. In other cases, they may be caused by an improper lifestyle. However, knowing how to recognize them is essential to understand when you need to seek medical attention.

What Are Palpitations?

Palpitations (or heart palpitation) is a disorder characterized by the perception that the heart is not beating at the “right” rate but is speeding up.

We speak of heart palpitation either in cases of increased heart rate (tachycardia), which can be caused by physical exertion or emotion, or in cases of irregularity of heart rhythm due to the manifestation of extrasystoles (evoking the feeling of the heart “missing a beat”).

Palpitations can be related to stress, strenuous physical activity, taking medication, or disease.

As a rule, although they can be frightening, palpitations have no severe consequences, and only in rare cases are they an indication of arrhythmia.

What Are the Symptoms of Palpitations?

Palpitations are characterized by:

  • A jump in the heartbeat, which gives a sense of shaking in the chest;
  • An abnormal rhythm of the heartbeat;
  • An accelerated heartbeat;
  • An entirely irregular rhythm.

These symptoms can be felt in the throat, neck, and generally in the chest, both while at rest or in motion. If the palpitations last only a few seconds, there is generally no cause for concern.

What Are the Causes of Palpitations?

The leading organic, noncardiac causes of palpitations include:

  • Intense emotional states due to anxiety, stress, or panic attacks;
  • Excessive physical activity;
  • Psychostimulant substances such as nicotine or caffeine;
  • The use of pseudoephedrine nasal decongestants;
  • Fever;
  • Hormonal changes due to menstrual cycle, pregnancy, or menopause;
  • High or low levels of thyroid hormones;
  • Hyperthyroidism.

Major risk factors that can cause palpitations include:

  • Stress;
  • Anxiety, depression, and panic attacks;
  • Pregnancy;
  • Use of psychostimulant drugs;
  • Heart disease, with arrhythmia or impairment of cardiac function.

Palpitations: When to Have a Cardiology Examination?

If palpitations are felt with increasing frequency, they may indicate heart distress, and it is best to ask for a cardiological examination.

In particular, the following are signs that should not be underestimated:

  • Chest pain;
  • Fainting;
  • Shortness of breath and wheezing;
  • A feeling of dizziness or lightheadedness.

Palpitations: Which Tests to Do for a Diagnosis?

If the doctor suspects that the cause is related to heart distress, they may prescribe specific tests, such as:

  • The Electrocardiogram (ECG) detects the electrical impulses generated by the heartbeat through sensors applied to the chest to detect abnormalities that could explain the occurrence of palpitations;
  • The Holter monitor requires electrodes attached to the chest connected to a handheld device that monitors heart function for 24-72 hours;
  • The event recorder is the recording of the electrocardiographic trace that monitors the heart rhythm through the implantation of a small battery-powered device. The test is prescribed when arrhythmias are not constant but discontinuous (e.g., they appear only once a week);
  • The echocardiogram uses ultrasound to understand whether the heart has abnormalities in the ventricles or valves.  

Can Palpitations Be Prevented?

The most effective way to prevent or contain the risk of palpitations is to follow specific steps:

  • Try to relieve stress through meditation techniques, deep breathing, and exercise;
  • Avoid caffeine and energy drinks, which can increase the heartbeat;
  • If prescribed by the physician, use anti-anxiety drugs;
  • Avoid taking drugs.

What May Be Hiding Behind Palpitations?

Heart palpitation can indicate cardiac arrhythmias that, if not detected in the short term by the cardiologist, can lead to syncope or cardiac arrhythmias such as atrial fibrillation, ventricular tachycardia, or ventricular extrasystole.

Atrial fibrillation is undoubtedly the most frequent arrhythmia in the general population (estimated at 2-3 %). It is characterized by irregular heartbeat and, if not diagnosed in time, can also cause ischemic stroke. 

Ventricular extrasystole, on the other hand, is characterized by an extra beat, generally benign, but can lead to structural cardiomyopathy in a minority of cases. 

Ventricular tachycardia is a dangerous arrhythmia, usually associated with a previous myocardial infarction or dilatation of a ventricle.

The 24h ECG Holter is usually sufficient to make the diagnosis.