Is palpitations a sign of heart discomfort or a sign of danger? Find out the causes and ways to get rid of them

Has it ever happened to you—suddenly, your heart starts fluttering like an eager bird? You feel short of breath, your throat feels dry, your palms are sweating… It feels like your heart is about to burst. Palpitations—we have all experienced this common but frightening feeling. Maybe while sitting in an exam hall, maybe before your first love proposal, or sitting in the office during an important presentation. But when these palpitations come for no reason, while sitting alone, after waking up—then the question arises, “Is this just nervousness, or a sign of some hidden heart disease?” To find the answer to this question, today’s in-depth discussion is about the causes and solutions behind this intense, sometimes terrifying feeling.

 

Causes of Palpitations: From Physical to Psychological, Multiple Faces

When we hear the word palpitations, the first thing that comes to our mind is the fear of heart disease. Of course, various heart problems can be responsible for it, but this is not the only reason. In fact, various factors in the complex network of our body-mind can give rise to this uncomfortable feeling. Let's find out in detail:

 

Cardiac causes:

• Arrhythmia (abnormal heart rate): This is the most important and sometimes dangerous cause of palpitations. This feeling occurs when the heart rate is irregular, too fast (tachycardia), too slow (bradycardia), or irregular (such as atrial fibrillation). According to data from the National Heart Institute in Dhaka, about 30-40% of patients with heart rhythm problems have 'palpitations' as their first complaint.
• Coronary artery disease: When the arteries supplying blood to the heart become narrow or blocked, the heart muscle suffers from a lack of blood and oxygen (ischemia). This can cause not only pain, but also palpitations, especially during physical exertion. Dr., Head of the Cardiology Department at Chittagong Medical College Hospital. According to Farhana Haque, “In middle-aged people, especially those who smoke or suffer from diabetes and hypertension, palpitations should be considered as an early sign of heart disease.”
• Heart valve problems: Mitral valve prolapse or other valvular heart diseases can also cause palpitations, especially when lying down or lying on the left side.
• Congenital heart diseases: Some birth defects can also cause palpitations in adulthood.
• Heart muscle disease (cardiomyopathy): Irregular heartbeats and palpitations can occur when the heart muscle becomes weak or thickened.

Physical causes indirectly related to the heart (non-cardiac causes):

• Anemia: When the red blood cells or hemoglobin in the blood decrease, the heart has to beat harder and faster to supply enough oxygen to the body. This extra work causes palpitations. Iron deficiency anemia is very common in Bangladesh, especially among women and children.
• Thyroid gland problems: Hyperthyroidism (excess thyroid hormone) causes the body's metabolism to speed up, the heart rate increases, and the chest to palpitate. Hypothyroidism (hormone deficiency) can also sometimes cause irregular heartbeat. Statistics from the Endocrinology Department of Bangabandhu Sheikh Mujib Medical University show that the rate of thyroid-related chest palpitations is gradually increasing in urban areas.
• Fluctuations in blood sugar levels: If you have diabetes, you may experience palpitations, sweating, and trembling during hypoglycemia (excessive decrease in blood sugar) or sometimes hyperglycemia (excessive increase).
• Low blood pressure (hypotension): When blood pressure suddenly drops, the heart beats faster to maintain blood flow to the brain, which can cause palpitations.
• Fever: When the body temperature rises, the heart rate naturally increases.
• Dehydration or electrolyte imbalance: Lack of water in the body or a deficiency of important minerals like potassium and magnesium can disrupt the electrical activity of the heart.
• Pregnancy: During pregnancy, blood volume increases and hormonal changes occur, which can cause the heart rate to increase slightly and palpitations may be felt.
• Menopause: Many women experience hot flashes, sweating, and palpitations due to hormonal fluctuations during menopause.

Mental and emotional causes:

• Anxiety: During stress, worry, or a panic attack, the body goes into ‘fight or flight’ mode. The hormone adrenaline is released, which causes the heart rate to increase, breathing to increase, blood pressure to increase, and chest palpitations to begin. “In about 50% of cases of people who come to our clinic with palpitations, the underlying cause is anxiety or panic disorder. It is important to remember that stress can cause physical symptoms.”
• Panic disorder: This is characterized by sudden, intense fear and physical symptoms (palpitations, shortness of breath, chest pain, fear of death).
• Depression: Palpitations are one of the physical manifestations of long-term depression.

Lifestyle and external factors:

• Caffeine: Excessive consumption of tea, coffee, cola, or energy drinks can cause increased heart rate and palpitations.
• Nicotine: Nicotine in cigarettes or tobacco products increases heart rate and constricts blood vessels.
• Alcohol: Irregular heartbeat can also occur during excessive drinking or a hangover.
• Illegal drugs: Drugs like cocaine, amphetamines, and even marijuana can cause rapid and irregular heartbeats, which can be very dangerous.
• Some over-the-counter and prescription medications: Pseudoephedrine in cold and cough syrups, some asthma inhalers, thyroid medications, some high blood pressure medications (such as when stopping beta-blockers), and even some antibiotics can cause palpitations as a side effect. Be sure to tell your doctor if this happens after starting any medication.
• Excessive physical exertion: Exercise naturally increases the heart rate, which may persist for some time after stopping exercise.
• Overeating or certain foods: Eating very heavy, fatty, or spicy foods, or those with food allergies (such as gluten, MSG), may cause palpitations immediately after eating.

When to see a doctor? Recognize the danger signs

Feelings of palpitations are often temporary and harmless. But if you have certain symptoms, it is important to seek medical attention immediately. These symptoms may indicate a serious problem with your heart or other parts of your body:

• Chest pain or pressure/tightness: Especially if the pain spreads to the left arm, jaw, neck, or back (a classic sign of heart disease).
• Severe shortness of breath: Shortness of breath during normal activity or with little exertion.
• Fainting or dizziness (syncope or presyncope): Dizziness or fainting with palpitations is a very dangerous symptom.
• Extreme weakness or fatigue: Feeling unusually weak.
• Sweating heavily or breaking out in a cold sweat with palpitations.
• A heart rate that is over 120 beats per minute (at rest) or is very irregular (such as sometimes fast, sometimes stopping).
• If you already have heart disease, diabetes, or high blood pressure and start having new or changed types of palpitations. Palpitations last for a long time (more than a few minutes) or come back frequently.

“I just have palpitations, no pain” – don’t be alarmed. Especially in the case of the elderly, smokers, diabetics, patients with high blood pressure or high cholesterol, or those with a family history of heart disease, any new or unusual palpitations should be taken seriously and a doctor should be consulted. Dr. Ariful Islam, of the emergency department of Apollo Hospitals in Dhaka, says, “Many patients come to the emergency room just because they have ‘palpitations’, and tests show that they are actually symptoms of a heart attack. So it’s never too late to be careful.”

Diagnosis of palpitations: What tests can be done?

• When you go to the doctor with palpitations, he or she will first take a detailed history of you:
• What does the palpitations feel like (fast, strong, skipped, irregular)?
• When does it start and how long does it last?
• Are there any triggers (food, exercise, stress, certain postures)?
• Other symptoms (pain, shortness of breath, dizziness, sweating)?
• Your medical history (illness, surgery)?
• Family history?
• What medications, vitamins, or supplements are you taking?
• Lifestyle habits (smoking, alcohol, caffeine, drugs)?

A physical examination will then be performed, especially listening to the heart and lungs. Then, one or more of the following tests may be recommended to determine the cause:

Electrocardiogram (ECG or EKG): This is a snapshot of the heart's electrical activity. It is best to have an ECG done during palpitations, as this is when the problem is most likely to be detected.

1. Holter monitor: This is a portable ECG device that records your heart rate for 24 hours or more (usually 24-48 hours). It detects irregularities that occur during daily activities.
2. Event monitor: This is used when palpitations are less frequent. When you experience symptoms, you turn on a small device and record them.
3. Echocardiogram (Echo): This is an ultrasound test that evaluates the structure, size, pumping ability, and valve function of the heart. It is very important in determining whether there is heart disease.
4. Blood tests: Blood tests are done to check for anemia, thyroid function, electrolytes (potassium, magnesium, calcium), blood sugar levels, and an enzyme (troponin) that indicates heart damage.
5. Treadmill test (stress test): Heart function and heart rate are monitored during exercise. This is especially useful if palpitations develop during exercise.
6. Cardiac event recorder (implantable loop recorder): This is a very rare but serious irregularity that is implanted under the skin and records the heart rate over a long period of time (up to a year).

Palpitations Treatment: Treatment and Home Management

Treatment for palpitations depends entirely on the underlying cause. Only after the cause is identified can appropriate measures be taken.

If a specific disease is identified:

• For arrhythmia: Medication (anti-arrhythmic drugs), cardiac ablation (a procedure to destroy abnormal electrical pathways), pacemaker or implantable cardioverter-defibrillator (ICD) may be inserted.
• For coronary artery disease: Lifestyle changes, medication, angioplasty and stenting or bypass surgery.
• For thyroid problems: Medication, radioactive iodine or surgery for hyperthyroidism; thyroid hormone replacement for hypothyroidism.
• For anemia: Iron, vitamin B12, folic acid supplements or other treatments, depending on the cause.
• For high blood pressure: Medication and lifestyle changes to control blood pressure.

If anxiety, worry, or panic disorder is the cause:

• Counseling or psychotherapy: Cognitive behavioral therapy (CBT) is very effective in dealing with anxiety and panic attacks. It teaches you to recognize and challenge negative thoughts, as well as relaxation techniques.
• Medication: Your doctor may prescribe anti-anxiety medications or antidepressants (such as SSRIs) if necessary. Remember, these medications should not be started, stopped, or changed in dosage without your doctor's advice.
• Stress management: Regular meditation, mindfulness practice, yoga, and pranayama (breathing exercises) can help reduce anxiety and regulate your heart rate.

Lifestyle Modification: In many cases, especially if the cause is lifestyle-related or to reduce the risk of heart disease, these changes are key:

• Caffeine and Nicotine Elimination: Avoid tea, coffee, cola, energy drinks, and all types of tobacco products (cigarettes, cigars, chewing tobacco). Note that even after cutting out caffeine, headaches or palpitations may increase for the first few days, but will subside later.
• Alcohol Limitation or Elimination: Alcohol, especially in excess, is one of the triggers for irregular heartbeat.
• Controlled and nutritious diet: Eat plenty of vegetables, fruits, whole grains, lean protein (fish, chicken). Reduce processed foods, excess salt, sugar, and unhealthy fats (trans fats, saturated fats). Increase iron and vitamin C-rich foods if you are anemic. Follow the recommendations of the Food and Nutrition Department of the Bangladesh Health Department.
• Regular physical exercise: At least 150 minutes of moderate aerobic exercise (brisk walking, cycling, swimming) a week strengthens the heart, lowers blood pressure, and relieves anxiety. However, if you have heart disease, adjust the type and amount of exercise with the advice of your doctor.
• Adequate sleep: 7-8 hours of deep sleep every day is very important. Lack of sleep can increase anxiety and heart rate.
• Stress management: Stress is inevitable in daily life. So practice relaxation techniques regularly. Deep breathing (diaphragmatic breathing), progressive muscle relaxation, meditation, and spending time on your favorite hobby—these help reduce stress.
• Drink enough water: Drink enough water and fluids throughout the day to avoid dehydration.

Some home or immediate remedies (if not contraindicated):

• Vagal maneuvers: These techniques can stimulate the vagus nerve and slightly lower the heart rate. For example: coughing loudly, trying to breathe out through your nose while holding your mouth closed (Valsalva maneuver), immersing your face in cold water (dive reflex), or sucking on ice cubes. Keep in mind, however, that these may not work in all cases and should not be attempted if you are in cardiac arrest or have severe chest pain.
• Attempts to calm down: If anxiety is causing your palpitations, sit in a quiet place and take deep breaths. Inhale through your nose for 4 seconds, hold for 7 seconds, and exhale through your mouth for 8 seconds. Repeat. Tell yourself that this is temporary and that you are calming down.

The experience of palpitations is certainly unpleasant, but it is not always dangerous. Listen to your body's messages carefully. Whatever the reason, being aware at the right time and taking the necessary steps is the key. If it is due to anxiety or lifestyle, positive changes can relieve you of this discomfort. And if it is a sign of a physical illness, early diagnosis and treatment can avoid major complications. Your heart is working non-stop for you—its 'palpitations' signal demanding a little care and attention.

Understanding this language of the heart called palpitations is the first step on the path to your well-being. Do not ignore this feeling, but rather take care of both physical and mental aspects with importance. Because, a healthy heart is the best companion for life. Decide to make positive changes in your lifestyle today and contact a qualified doctor immediately if you have any concerns.

 

 Know (FAQs)

Question: What should I do if I suddenly feel palpitations while lying down at night?

 
Answer: First, try to calm down. Sit down or change your sleeping position. Take deep breaths. If you are also experiencing chest pain, shortness of breath, dizziness, or fainting, or if the palpitations last for a long time (more than a few minutes), go to the nearest hospital emergency room immediately. If this happens repeatedly at night, seek medical advice during the day. Night palpitations can also be caused by acid reflux, sleep problems (sleep apnea), or sleeping in a certain position.
Question: Does having palpitations mean you are having a heart attack?
Answer: No, it is wrong to think that having palpitations means you are having a heart attack. There are many common and harmless causes of palpitations, such as anxiety, caffeine, or overexertion. However, if palpitations are accompanied by chest pressure or pain (especially radiating to the left arm/jaw), severe shortness of breath, heavy sweating, dizziness or fainting, these may be signs of a heart attack and immediate medical attention is necessary. Seek medical attention if you have any doubts.

Question: How can I control my palpitations due to stress or anxiety?

 
Answer: The most effective way to control stress-related palpitations is through relaxation techniques. Practice deep breathing exercises (4-7-8 method), progressive muscle relaxation, mindfulness meditation or yoga regularly. Avoid caffeine and nicotine. Ensure adequate sleep. Do light exercise regularly. If the problem feels severe or out of control, consult a psychologist or psychiatrist. Remember, your feelings are valid and you have the right to get help.

Question: I am pregnant and have frequent palpitations. Is this normal?

 
Answer: Mild palpitations or a slightly faster heart rate are quite common during pregnancy. Blood volume increases by about 50% during pregnancy, which makes the heart work harder. Hormonal changes are also responsible for this. However, if the palpitations are very severe, long-lasting, or accompanied by chest pain, shortness of breath, dizziness, or fainting, then definitely inform your gynecologist or obstetrician. Anemia or thyroid problems can increase palpitations during pregnancy, which also needs to be checked.

 

Question: What are some home remedies to reduce palpitations?

• Answer: Depending on the cause, some home remedies may help:
• Avoid triggers: Reduce caffeine (tea, coffee, cola), nicotine (cigarettes), alcohol, heavy or spicy foods.
• Hydration: Drink plenty of water.
• Relaxation: Breathe deeply, meditate, listen to music, take a warm bath.
• Vagal maneuvers (with caution): Cough loudly, immerse your face in cold water, or try to breathe out through your nose with your mouth closed (only if you feel well and do not have chest pain).
• Electrolytes: On the advice of a doctor, you can eat foods rich in potassium (bananas, coconut water) or magnesium (almonds, pumpkin seeds), but supplements should not be taken without consulting a doctor.
• Exercise: Regular light to moderate exercise (such as walking) strengthens the heart in the long term and reduces stress. Remember, home remedies are only for mild or temporary palpitations and are not a substitute for medical treatment. See a doctor if symptoms persist or are severe.