When to Worry About Heart Palpitations

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

At some point in our lives, most all of us will experience heart fluttering, racing, skipping, or another kind of irregular heartbeat. It’s incredibly common. But because it affects the heart, it also can be incredibly frightening.

Myself, I’ve had a couple episodes with PVCs (premature ventricular contractions). Let me tell you, they get your attention!

I saw hundreds of patients over the years who were concerned about heart palpitations. In many of those cases, the irregular beats turned out to be 100 percent benign—nothing to worry about. But I also saw a lot of people whose palpitations were their bodies’ way of telling them that their heart needed help.

What Is a Heart Palpitation?

Heart Palpitation Risk Depends on the Cause

The most important part of evaluating heart palpitations is determining what’s causing them. I always liked to start by asking patients some questions about their lifestyle:

  • Were they eating too much sugar, caffeine, or other foods that cause palpitations?
  • How much stress and anxiety did they have in their lives?
  • Were they feeling emotions that they didn’t feel they could talk about?
  • Did their palpitations tend to happen at a certain time? (A heart racing at night was common.)
  • What medications are they on?

The answers to these questions helped me understand whether external issues could be causing the skips, jumps, or flutters. If, after I finished my work-up, all of a patient’s risk factors fell into this bucket, I didn’t worry too much about their heart palpitations. Instead, I’d start working with them on adopting new habits that could address the problem.

What concerned me was when I found internal issues with the heart that could be causing someone’s palpitations, or that could become dangerous if it was combined with palpitations. Here are six specific examples of when it’s right to worry…

6 Causes of Heart Palpitations that Are Reason for Worry

Diastolic Dysfunction

In people who have diastolic dysfunction (DD), there are problems with the structure and function of the heart—a major risk factor when evaluating whether palpitations are dangerous. With a normal heart, I never worried too much about irregular beats. But when a patient’s heart was compromised in some way, it was a different story.

With diastolic dysfunction, the ventricles (the lower chambers of the heart) lose their elasticity and can’t fully relax and fill with blood like they’re supposed to. This causes the heart to beat faster and less efficiently.

Sometimes we’ll see palpitations as a symptom of DD, but I worry more about how they can affect the disease’s progression (it can lead to full-blown heart failure) and their potential to disrupt an already struggling heart.

A major issue with DD is all the extra wear and tear it puts on the heart. When you throw in irregular beats, it adds to that already heavy workload. Even more problematic, though, is that irregular beats have the potential to disrupt electrical signals and lead to life-threatening arrhythmias.

If you’re having heart palpitations or it feels like your heart’s racing, diastolic dysfunction is something you’re going to want to have your doctor assess—doubly so if you’re a woman. DD is much more likely to occur in women than in men.

High Blood Pressure

High blood pressure and heart palpitations are a bad mix for one of the same reasons that diastolic dysfunction is—the workload they put on the heart. High blood pressure is a major cause of DD, and heart palpitations can raise risk even more.

If you have both high blood pressure and palpitations, you must keep your blood pressure in check. Make sure you’re eating an anti-inflammatory diet,  managing your stress, and, if necessary, taking prescription medication; I also recommend taking supplements that can help lower blood pressure. (Check out my full blood pressure–lowering plan.)

Mitral Valve Prolapse

Another cause of heart palpitations that can be worrisome is mitral valve prolapse, or MVP.

If you have MVP, it means the valve separating the lower left chamber of the heart from the upper left chamber (the atria) doesn’t close properly. This allows blood to leak backward from the atria into the ventricle, and it puts extra pressure on the ventricle to pump it out. To you, it may feel like your heart is skipping beats, fluttering, or beating extra hard.

Sometimes palpitations are a sign that you’ve developed MVP or that your MVP is getting worse. So again, be sure you get any irregular sensations checked. A slight leak isn’t necessarily dangerous, but moderate to severe leaks need attention and care if you want to prevent long-term damage.

Like diastolic dysfunction, we see MVP more in women than in men—and often in younger women in their 30s and 40s. Unfortunately, a lot of people that age don’t think they’re at risk for heart problems so they ignore warning signs like irregular beats. Don’t do this!

Atrial Fibrillation

A-fib is a serious arrhythmia that increases your chances of throwing a blood clot and having a stroke. I was always concerned when patients complained of symptoms associated with it, including heart palpitations.

In people who have A-fib, the atria quiver instead of rhythmically contracting like they’re supposed to. Because of that, blood pools in them longer than normal and can thicken and clot. The clots can then move into the brain and block vital blood flow.

You can live a full and active life with A-fib, but it’s essential that you be on some sort of blood thinner to protect against clotting. When you have your heart palpitations evaluated, make sure your doctor checks for A-fib as the cause.

Spinal Misalignment

If you didn’t have this on your short list of heart palpitations causes, don’t worry. It wasn’t on mine, either, until I met Dr. Martin Gallagher. He’s both an M.D. and a chiropractor, and he’s worked with a number of patients whose irregular heartbeats were improved with chiropractic adjustments.

This isn’t something that tends to get written up in medical literature, but it makes sense. Even slight misalignments in the spine can put pressure on your nerves, which stimulates the sympathetic nervous system to release adrenaline, cortisol, and other stress hormones. And stress, whether physical or emotional, can be a major cause of heart palpitations.

On its own, spinal misalignment isn’t as immediately dangerous as A-fib, MVP, or diastolic dysfunction. But it’s worth noting because the chronic stress it causes drives a lot of inflammation in the body. Too much inflammation speeds up the aging process and raises your risk for heart disease, insulin resistance, and other long-term degenerative conditions.

Hypersensitivity to EMF

Finally, I want to mention EMFs (electromagnetic fields) as a troubling cause of heart palpitations. EMFs are the electromagnetic frequencies we’re exposed to from all those wifi routers, cell phones, baby monitors, tablets, and other electronic gadgets we can’t live without.

You can’t touch or see EMF, but there’s increasing evidence that it can affect the body in a lot of negative ways, including overstimulating the sympathetic nervous system. Heart palpitations can be an early sign that your stress response is in overdrive and that you need to take steps to limit your exposure and be smarter with your devices. A good place to start is changing how you use your cell phone. For example, don’t carry it pockets that rest against your body, use speakerphone, and when you can, send a text instead of making a call. I also tell people with EMF hypersensitivity to practice grounding, which helps balance the nervous system and keep your stress response in check.

Understanding the Invisible Threat: 5G Health Risks

Don’t Ignore the Warning Signs

If there’s one parting thought I can impress on you, it’s to never ignore heart palpitations.

No matter what age you are or how good of shape you’re in, if you feel fluttering, skipping, or any other kind of irregular heartbeat, get it checked out by a cardiologist. The cause of your situation may well turn out to be nothing to worry about. But if that’s not the case, the sooner you begin treatment, the better off you’re going to be. This is definitely one of those instances when it’s better to be safe than sorry.

References and Resources

© Stephen Sinatra, MD. All rights reserved.

Leave a Reply


  1. brit

    on August 4, 2018 at 11:46 am

    which kind of blood thinners can be safely used for AFib? I am afraid of the new NOAC’s and possible brain bleed. How about Nattokinase/Fish Oil etc?

  2. Verlena Hayes

    on August 9, 2018 at 10:32 pm

    I was having heart palpitations due to my thyroid. I had nodules on my thyroid which threw me into hyperthyroidism. I received a total thyroidectomy and the heart palpitations are now gone!

  3. HeartMD Editor

    on September 17, 2018 at 2:02 pm

    Hi Brit,
    When it comes to A-fib, blood thinners can be life savers. Natural blood thinners are not generally advisable when it comes to a serious condition such as A-fib. Nattokinase, lumbrokinase, and fish oil are potential options for those can’t tolerate pharmaceutical blood thinners. A natural approach would need to be discussed with your cardiologist and very carefully monitored.

  4. Renee

    on September 21, 2018 at 1:47 am

    I have a friend who was placed on Eliquis when it was discovered on an EKG that he was in afib. He received shock treatment and has been out of afib for more than a year now. Why is he still being prescribed Eliquis?

  5. Jacqueline L

    on September 28, 2018 at 10:19 pm

    My name is Jackie I’m 56 years old I have been diagnosed with heart failure and I have really bad palpitations I’m on Xarelto .. metoprolol and I’ve had a heart attack I’m also on fluid medication I’ve been told that I have a left aneurysm that needs to be repaired possibly I have been having shortness of breath night sweats very fatigued and I’m just wondering the benefits about getting it repaired I recently read this he passed that they can do but if you have to have an open heart surgery to get this done so I’m just wondering should I get something done before my symptoms become worse and wouldn’t make me feel better if I got it repaired I’m on entresto I’m beginning to experience a lot of shortness of breath 14 and palpitations have gotten worse I do have an appointment to see my heart doctor soon but I wanted an opinion from a thoracic surgeon about whether the repair was possible and it would make me feel better your thoughts on that.. I also have several stents thanks

  6. Jacqueline L.

    on September 28, 2018 at 10:22 pm

    My name is Jackie I’m 56 years old I have been diagnosed with heart failure and I have really bad palpitations I’m on Xarelto .. metoprolol and I’ve had a heart attack I’m also on fluid medication I’ve been told that I have a left aneurysm that needs to be repaired possibly I have been having shortness of breath night sweats very fatigued and I’m just wondering the benefits about getting it repaired I recently read this he passed that they can do but if you have to have an open heart surgery to get this done so I’m just wondering should I get something done before my symptoms become worse and wouldn’t make me feel better if I got it repaired I’m on entresto I’m beginning to experience a lot of shortness of breath 14 and palpitations have gotten worse I do have an appointment to see my heart doctor soon but I wanted an opinion from a thoracic surgeon about whether the repair was possible and it would make me feel better your thoughts on that.. I also have several stents thanks ..10 yrs left ventricular aneurysm

  7. Kirk

    on December 18, 2018 at 10:59 am

    I have been on pain killers for a couple years. They switched me from oxycodone to a morphine based pain killer. Can either oxycodone and morphine type pain killers cause the heart to flutter? I’ve had a stress test several weeks ago with a (what ever the procedure is called when a teck runs this gun like thing over my chest). It all came out ok. A couple of extra heart beats did show up on the test. Anyway, let me know, thanks…

  8. Marilyn C.

    on December 18, 2018 at 6:34 pm

    Hi, my name is Marilyn ..I’ve recently started a fast heart rate only at night that awakes me to where I can’t sleep. I have no thyroid only the synthroid for replacement. last checked my TSH was 0.18 not sure if that’s the cause of the fast heart rate at night. my dr lowered my dosage from 88microgram down to 75 but nothing has changed as far as the fast rapid heart rate..When dosage is changed does it take several weeks to see a change

  9. Margaret Head

    on December 19, 2018 at 5:32 pm

    I am going to be 93 yrs old next month. I was having what my heart specialist concluded was afiib. He started me on a medication I could not tolerate and the other medication was not recommended for my age. I immediately ordered Dr Sinatra’s Heart Healthy vitamins for women and the Omega Q Plus. That was almost a year ago and I have no more symptoms. I wish I could shout this to the world! The reason I chose Dr Sinatra was because a few years ago my daughter was a semi-invalid because of a heart problem. She took her little dog to a veterinary and she mentioned the severity of her heart problem to him. He advised her to follow Dr Sinatra’s advice which she did. She was remarkably better for years even though her heart was enlarged. A sensible diet is required for heart health also.

  10. HeartMD Editor

    on December 28, 2018 at 10:05 am

    Hi Margaret,
    We are thrilled to hear that the Omega Q Plus has been such a help to you!

  11. Margaret E Head

    on December 28, 2018 at 11:09 am

    I ordered another 3 month supply of it. I am grateful for my healthy heart.

  12. Jane

    on December 31, 2018 at 2:42 am

    I am a 58 year old woman, and recently I’ve have had a lot of palpitations. They’re strong enough that they last a while and make my heart cartwheel or flip – they are quite frightening and now occur daily. I went to a doc / cardio – and he had the nurse do an EKG which i guess was normal. I’m being sent to get the “Boston Test” which I’m told provides much more info than a lipid panel. After that result comes back, he’ll order an Echo test. But after reading the above, I’m wondering why he’s not assessing the palpitations? Until a year ago, I had cholesterol of 220 for about 30 years, and always normal blood pressure, however, since august of 2017, cholesterol has climbed to 310, and BP goes from 140-208 with 150s to 170’s averaging. Should I go to another doc? I feel different. Frequent palpitations, fatigue, and more shortness of breath on climbing stairs. I’m a single mother, and want to make sure I don’t have a heart attack. Father had one at 30 and then pacemaker and aortic aneurysm, and fatal heart attack. Brother had open heart surgery at 40.

  13. Ellen

    on February 13, 2019 at 8:35 am

    I am a 66 yr old woman and for 2 months have been ill which started with a flu-like virus. I coughed so much that it gave me palpitations and was admitted into hospital for a 24 hour heart monitor.
    I was later discharged when after resting 2 days my coughing stopped and heart rate returned ok and an ECG was passed clear.
    My GP has ordered me to be put on a 24 hour portable ECG machine but that isn’t fitted for another 4 weeks.
    I have since felt very tired, no energy and my heart rate increases with exertion and I start to cough again.
    My appetite is still very good.
    Should I request the portable ECG to be done sooner if possible? Do you think this is anything to worry about?
    Thank you.

  14. Heidi L.

    on March 1, 2019 at 7:59 am

    I am 75 years old and go through lots of stress ,I have a daughter 54 in the last stages of cancer through out her body ,weighs only 80 more pounds and it’s just a matter of time ,and she lives 800 miles from me I just got back I am not allowed to stay longer then 4 days they live in a big house but as they choose they want just their adult kids there till it’s over , her siblings are not allowed to be there either ,
    I woke up this morning with my heart racing but it stopped right away again my middle pleasure was 84 and now is Down to 80 and keeps going down ,I had it a long time ago maybe 4 years ago off and on , but my blood pressure meds were upped , but blood pressure and heart rate is normal
    Can stress have something to do with that ?

  15. Hannah

    on March 22, 2019 at 9:48 pm

    I am 23 years of age, I think I’m a little bit stressed out. At first, i didn’t understand what was happening cause I could feel my heart beat faster one night as I was about to sleep, I sat up and did some breathing exercises which helped me and I slept with no problem but 2 night later, I woke up to use the bathroom but couldn’t go back to bed for a while but after I took warm water, it really helped me and I felt better but then again it happened later that day. what do you think is causing this. My symptoms are heart pounding fast, feeling cold and shaky. I didn’t have fever, headache or any other thing.

  16. Robin

    on April 3, 2019 at 6:55 pm

    I have a 33 year old daughter who has had two premature children. She developed palpitations shortly after the first was born eight weeks early four years ago. She described them as a thump and she could feel the blood rushing to her limbs. After several visits to the local hospital over a period of time she was told her heart was ok and they were caused by anxiety. She told them they were causing her anxiety and has lived with them since, mentally telling herself she would just have to put up with them for the rest of her life. At 26 weeks pregnant with her second child she had about eight weeks stay in a hospital due to the possibility of miscarrying. The palpitations settled somewhat but did not go. This child is now about 9 weeks old. I visited her last week and found her on the lounge quite upset after her heart had suddenly revved up to almost 160 beat per minute and she could hardly breathe. She didn’t want to go to the hospital because she felt they would tell her it was just anxiety. She said she wasn’t anxious before this happened. I gave her some potassium and magnesium cell salts that seemed to quieten the speed of the heart and it came down to around 100 beats after about forty minutes of giving her these cells salts every ten minutes and checking her pulse rate each time. Her heart was under 100 beats the next day and she said she was ok but tired. She works on a computer and I have told her about the EMF, she was also eating quite a bit of food with salt to try to calm her palpitation, which she said seemed to help. I think her potassium and magnesium levels may have gotten out of whack but I don’t know. Any ideas. Should she get her heart checked again by a heart specialist? I feel heart palpitation that continue to go on day after day for four years can’t be good for the heart, it must have some effect on it.

  17. Linda B

    on May 1, 2019 at 3:26 pm

    I am a 65 year old woman. I have chronic insomnia now working with a sleep lab. I have had 4 major back surgeries resulting in chronic pain. I fractured my foot in 4 places and can’t walk very well or for very long periods of time. I’ve been diagnosed with stress and anxiety. My primary nurse practioner asked me last week if I had ever noticed my heart fluttering which I have occasionally. I’m taking 25 mg. twice a day of metoprolol. Is this something I should worry about?

  18. jeff l

    on June 27, 2019 at 7:15 pm

    I am a 52 year old male that has had 2 heart attacks. My first at the age of 46 after a bout of S.V.T. that apparently tripped over to heart attack and then again when I was 50. Now I live my life wondering when the next one is coming. I want to live for many many years to come. I used to weigh 280 lbs at 5’6. I have changed my lifestyle,eating habits and smoking habits. I’ve lost 80 lbs so far, I eat a lot better and smoke maybe a cigarette a day. They didn’t install any stents at the time of my first or last angiogram because apparentlythey found no reason too. Stating that my heart attack was due to squeezing of vessel. Do I need certain medications to fix my condition or surgery to fix? My last angiogram report states this word for word….CORONARY ANGIOGRAM FINDINGS:
    Left ventricular angiogram, left ventricular angiogram revealed good
    contractility with ejection fraction 55% to 60% normal.

    Selective coronary angiogram, right coronary artery was dominant and no
    significant obstruction seen.

    Left main, left main is short, bifurcate survey, no disease seen.

    Left anterior descending artery, vessel is large size, has a mid LAD
    muscle bridge, squeezes almost to the 90%. With good distal flow, no
    distal disease and diagonal is normal.

    Circumflex system proper is normal.

    Obtuse marginals are normal.

    Muscle bridge of the mid LAD with normal blood flow, normal ejection
    fraction…..Wanting to live to see my great grandkids…..Thank you for your time….Best regards….Jeff L

  19. Gary W.

    on August 16, 2019 at 5:15 pm

    I am 52. I crushed a disc in my lower spine 15 years ago. I have been trying to get my family DR to do something about my back for 10 years. Finally got a Dr to take a better look. MRI showed bottom disc crushed and damage to spine above and below. 2 days latter went for my stress test. Ran the treadmill up to 180 bpm, all looked great. . . . until cool down. I was in AFIB. Straight to heart DR who put me on monitor and told me to do, what I normally do. Mow rough ground, move heavy shelving, etc. Had a few short episodes. Put my feet up, stretch my spine and it goes away. He put me on financial. Made it worse when I was in AFIB. Double the dose. Made it so bad I could hardly do anything.
    I told him I go into AFIB when I jar my spine; mowing, running on treadmill, lifting shelving. He said physical activity has nothing to do with it. I said not physical, spine jarring activity. I put my knees up, stretch my back it goes away. When it’s been hurt from these activities, had a few short episodes at night. I cannot sleep on back or belly. If I wake up on back and heart rate 120, lay on side with knees up and it returns to 65; like a switch.
    Heart DR tells me I need oblation. I stopped mowing, stopped spine jarring activity and stopped the flancinade. No AFIB since. Still very active. Heart DR does not believe me. Spine DR doesn’t either but I am getting fusion in a couple weeks. If the heart DR want’s oblation after spine fusion, I will demand wearing the monitor for another month to see if problem still exist.

  20. Ann U

    on October 3, 2019 at 2:04 pm

    I am 82 and have atrial -Fib and sometimes feel very weak. I am basically a very healthy 82 yr old, good mind, a bit overweight, but am happy in my life. I used to take your Omega 3 Plus etc. but since I am on Warafrin or Coumadin , I hesitate to take it, however, I always felt better when taking it. I am also on Lisinopril, and Diltiazam, potassium, and Levothyroxin. That is it for an old lady. I just want to get off the blood thinners and anything else. I hate meds. Can you help me. I know I probably spelled some of the meds wrong, but you being a smart cardiologist will know that I mean. Thank you Dr. Sinatra for all you do I have taken your supplements for quite a few years, but not in the last year. Please respond to me. God bless you for all you do to help we cardiac patients. Ann U.

  21. Al

    on July 7, 2020 at 7:21 pm

    My father recently suffered a minor hemorrhagic stroke. The cardiologist wants to put him Eliquis because he has some intermittent atrial fibrillations. I can understand the importance of blood thinners for an ischemic stroke but we have been hesitant to put him on the Eliquis due to the risk of more bleeding.
    What is your opinion of someone who’s suffered a hemorrhagic stroke taking Eliquis or other blood thinners?

  22. Sandi

    on July 13, 2020 at 2:15 pm

    Hello Al,
    This is what Dr. Sinatra has to say:
    Using anticoagulation medications or “blood thinners”, in folks with a history of a hemorrhagic stroke is a very delicate decision.
    I have had to face it many times in my practice, and even with a close family member. The risks have to be weighed quite carefully
    and thoughtfully against the intended benefit. Each person is individual and thus different in that regard. And whichever decision is made, it is often revisited regularly over time.
    I appreciate and concur with your concern. I would have to refer you back to your father’s own MD’s, who know the details of his case the best to advise you.

  23. Al

    on July 13, 2020 at 11:03 pm

    Dear Dr Sinatra,
    Thank you so much for your response. It confirms what I suspected and was worried about, I just was not sure if I was missing something.

  24. Marde Troxell

    on January 3, 2021 at 11:52 am

    Help for husband can’t breath. Lots of pvc. I give him magnesium. Dr put him on amoridone. Bad drug. Changing his personality. Was on for 5 yrs. Dr took him off said it wasn’t working. Now back on then wants to ablation on pvc

  25. dom muia

    on January 14, 2021 at 7:39 pm

    i take an ace-i and it causes me to have palpitations…must be high potassium..how could i lower the potassium ?? is there a better ace-i ? I take coversyl..thx

  26. Marlena

    on April 22, 2021 at 8:45 pm

    I had a heart attack last December in 2020. I was immediately rushed to the hospital and again rushed into a CT, angioplasty and given a medicated stent. I was 79 and had never had any history of heart issues. One artery was blocked 90%. I was put on Birlinta and aspirin. I had no idea what it would mean to my life style having a stent. I have been on Birlinta for four months. I am not a person that has ever taken drugs. Birlinta is horrible! I find that no doctor will tell me HOW to get off Birlinta and what supplements to replace Birlinta with. There has to be more than ONE way to handle CAD (Cardiac Artery Disease). Please, if anyone knows what to replace Birlinta with and how to proceed, I would be eternally grateful! All these medical blood thinners are dangerous. Everyone of them has serious side effects and many lawsuits! I have now spent $1,050 in four months slowly destroying my body with Birlinta.

  27. Diana S.

    on May 16, 2021 at 7:24 pm

    79 almost 80 on c ardizam 180 primarily for palpitations. Doing well I guess.
    When walking small hills got bad palpitations. Why???heart rate and BP were not that high. I think the palpitationx turned into panic attack as I had to driver 2 miles home.had xanax to help and rested for hours. Scary..

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