Are Heart Palpitations a Sign of a Heart Attack?

It is estimated that 16% of patients present to their primary care physician with heart palpitations. Heart palpitations are a pulsation or abnormal beating of the heart that someone describes as a “skipped beat” or a “fluttering” sensation.

What are heart palpitations?

Heart palpitations are a sensation in the heart described as when it starts beating faster, harder, or "skipping a beat". Most times, a person will feel these heart palpitations, but they often go away on their own. However, this happens if they are caused by outside issues such as stress or exercise.

Heart palpitations can typically be seen as different abnormalities on an electrocardiogram (ECG). An ECG records your heart's rhythm and serves as a diagnostic tool for your doctor.

What leads to heart palpitations?

Many different causes lead to heart palpitations and may help to explain why you have them. The ECG may show you have palpitations starting in your ventricles, atriums, or other structures in the heart that can point to the cause.

When the heart beats irregularly, it may signify that something more is going on. If heart palpitations are a new occurrence or you have a history of or are at risk for heart disease, you should see your physician immediately for a full workup.

Many different things can cause heart palpitations, and not all causes are heart-related.

Causes unrelated to heart

Non-cardiac causes of heart palpitations include:

• Alcohol use;
• Illicit drug use;
• Abnormal electrolytes;
• Illness and fever;
• Psychological concerns, such as anxiety and depression;
• Dehydration;
• Caffeine use;
• Exercise and physical-related stressors.

Heart-related causes

Cardiac-related causes of heart palpitations may include:

• Premature ventricular contractions (also known as PVCs, similar to a hiccup but of the lower chamber of the heart when it gives an extra squeeze);
• Ventricular tachycardia (the lower chamber of the heart beats too fast);
• Atrial fibrillation (the upper chamber of the heart beats too fast);
• Congenital heart disease (birth defects in the heart);
• Congestive heart failure (heart failure of the left side of the heart leading to a back of fluid in the lungs);
• Aortic Aneurysm (a balloon-like bulge in the large artery that carries blood from the heart to the chest and torso);
• Myocardial infarction (heart attack).

Symptoms of heart palpitations

Symptoms of heart palpitations can be described as a fluttering, pounding, racing, flip-flop, or skipped beat of the heart. Feelings typically occur in the left side of the chest where the heart is but can also be your whole chest and up in your throat.

Heart palpitations should not cause severe pain but may cause discomfort. Chest pain is also known as angina and can be a sharp pain, dull ache, or a crushing and burning sensation. Chest pain is considered an emergency as it could signify a heart attack. If you have chest pain, you should call 911 and seek treatment immediately.

Describing your heart palpitations as clearly and precisely as possible gives your doctor a clue about the cause. For example, the feeling of flip-flopping is thought to be caused by PVCs. However, rapid fluttering is believed to be caused by sustained irregular heartbeats called arrhythmias. Additionally, an irregular-feeling heart is believed to be atrial fibrillation, where the atrium of the heart quivers fast rather than beating. Furthermore, pounding in the neck or throat is thought to be caused by dissociation in the atrium and ventricles. The only way to know for sure is to undergo an ECG.

Heart palpitations and heart attacks

Data shows that 43% of heart palpitations are heart-related — but are not always heart attacks. Additionally, researchers found that 31% of heart palpitations are related to psychiatric causes, and 10% are from other reasons, such as illicit drug use, including caffeine.

Various diseases, medications, stress, etc., can cause heart palpitations. When the heart is under stress, such as when you have a heart attack, it can cause irregular rhythms that present as heart palpitations.

During a heart attack, a clot blocks the blood flow in a coronary artery leading to tissue death in the heart. When this happens, your heart may feel like it is flip-flopping or beating fast, along with the other signs of a heart attack.

Signs of a heart attack include:

• Chest pain or pressure;
• Lightheadedness, nausea, and vomiting;
• Pain in the jaw, neck, or back;
• Arm pain;
• Shortness of breath.

If you experience any of these symptoms, you should seek treatment immediately and call 911.

When to worry about heart palpitations

Life-threatening conditions can cause heart palpitations if they are related to a heart complication. While not all symptoms of heart palpitations are problematic, you should still have the causes ruled out by the doctor to ensure you are not at risk of further complications.

Sometimes heart palpitations are your body's way of letting you know you need to relax or treat yourself better. For example, it may signify that you need to slow down while running or drink more water while running. However, it could also be your body's way of telling you to reduce stress levels.

If you are pregnant or suspect you are pregnant, your body may have an increased heart rate due to the increased blood levels in your body. Small exertions, such as walking up the stairs, can cause heart palpitations in pregnant people. Even though you may occasionally get these symptoms when pregnant, it is still important to relay this information to your doctor for further testing.

You should seek medical attention immediately when your heart palpitations are continuous and do not go away. If resting, hydration, and a reduction of anxiety are not helping, then it could be a sign there is something more going on with your heart. Always trust your instincts. If you think something more is going on, have it checked out.

Any time you feel any signs or symptoms of a heart attack, including chest pain or shortness of breath, it is an emergency, and you should call 911 to get help.

Treatments for heart palpitations

To treat heart palpitations, your doctor will run a series of diagnostic tests to determine what is causing them. Diagnostic tests may include an ECG, blood tests, physical stress test, chemical stress test, or wearing a heart monitor at home.

If the palpitations are chronic and are caused by atrial fibrillation or PVCs, your doctor may perform a procedure called an ablation. During an ablation, your doctor will use a catheter to feed a small device up to the heart and burn the areas causing the problem.

Certain medications, such as calcium channel blockers or beta-blockers, may also help control the heart. Medication can be used with an ablation procedure to help correct the issue.

If the heart palpitations are not directly related to heart complications, then further investigation may need to be done to determine the cause. Specific causes of heart palpitations can be self-controlled.

Reducing your stress levels, smoking cessation, limiting alcohol intake, and drinking adequate amounts of water, may be ways to prevent heart palpitations from occurring.

If your heart palpitations are related to another illness, such as hormone imbalances, thyroid issues, anemia, or other conditions, then the underlying conditions need to be corrected to stop your heart palpitations.

Ultimately a workup to determine the cause will need to be done. If you feel chest pain, shortness of breath, loss of consciousness, or dizziness, then call 911 and report to the nearest hospital.