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.

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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.

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