Palpitations: Something to Ignore?

by Cristina Sciavolino-Day, MD

Have you ever felt a skipped heartbeat or even afluttering? This very common feeling is called apalpitation. It has even been described in romance novels when the beautiful damsel in distress notes that her heart dances with delight or skips a beat upon seeing her handsome knight in shining armor. Although most of these skipped beats are harmless, some may be associated with true cardiac issues that need further evaluation.

It is important to see your doctor if you have recurring palpitations or if they are associated with shortness of breath, dizziness, chest pain or confusion.

Most palpitation causes are triggered by things like strong emotions, hard physical exercise, or lack of sleep. Other causes include caffeine, nicotine, alcohol, cocaine, decongestants containing pseudoephedrine, and certain asthma medications. Certain medical conditions are linked with a higher chance of heart rhythm changes and palpitations. These include hyperthyroidism, an electrolyte imbalance (i.e. dehydration), anemia and high fever.

More serious problems such as heart disease, valve disorders or atrial fibrillation may be present. It is important that these conditions are ruled out as they may be life threatening if not diagnosed in time.

Testing is quite easy. This starts with your physician discussing your history followed by a thorough exam. An EKG would be performed at that time to look at your heart rhythm. To evaluate the rhythm for longer periods of time, a holter or event monitor may be required. Lab work is then ordered to rule out the presence of anemia, electrolyte disorders or a thyroid condition. If further investigation is warranted, an echocardiogram, which is an ultrasound of the heart, may be required to look at the heart valves. Finally, a cardiac pet scan may be added to rule out the presence of heart disease. A cardiologist or electro physiologist may be consulted if an abnormal result is found.

Once a structural cardiac cause is ruled out and a benign issue diagnosed, treatment is usually avoidance of what is triggering the palpitation. Stay well hydrated and avoid exercising in the peak heat times of the day. Limit caffeine and alcohol while avoiding nicotine. Optimize your stress control measures with meditation or yoga. Try to sleep eight hours a night. Avoid cold medications with pseudoephedrine. Try to optimize control of any medical conditions linked with arrhythmias. Try to reverse the anemia by finding out what is the cause of it. Control the thyroid condition and get your lab work checked as advised by your physician. Medications may be added for treatment cardiac conditions or if you are becoming more symptomatic from your palpitations.

Palpitations are sometimes so quick and fleeting that they are easily dismissed. However, it is important never to assume that simple things are minor in nature. They may not be. Communication with your physician is key. It may save your life.

Dr. Sciavolino-Day specializes in internal medicine focusing on wellness and prevention in her concierge practice. For further information please call 239.596.8702 or visit

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