The way we describe how someone makes us feel — that they make our heart flutter or skip a beat — is a cutesy phenomenon, in theory. But when heart palpitations strike for real, it can be an alarming experience.
“Palpitations are the sensation of a fluttering, pounding, irregular heartbeat or rapid heart rate,” said Dr. Ashul Govil, a San Francisco-based board-certified cardiologist and chief medical officer at Story Health.
“They’re most often felt in the chest or neck and can sometimes be associated with lightheadedness, chest discomfort or shortness of breath.”
Heart palpitations are one of the most common reasons for people to visit a cardiologist, according to the Cleveland Clinic. The cause is usually benign ― a random blip ― and the symptoms short-lived.
“Sometimes there are clear triggers, such as caffeine, stress or anxiety, and modifying these triggers can help reduce palpitations,” Govil said. But if they still happen despite your tweaks, you might need to dig a little deeper, starting with these sneakier culprits:
You’re dehydrated
Dehydration causes the amount of blood circulating in your body to decrease, so your heart has to pick up the slack by beating faster to pump blood throughout your body, potentially leading to palpitations in the process.
“Additionally, dehydration can cause palpitations by disrupting the electrolyte balance in the body,” said Dr. Kaustubh Dabhadkar, a preventative cardiologist based in Charlotte, North Carolina. In particular, low potassium or magnesium levels can cause skipped beats or extra beats of the heart.
To minimize palpitations caused by dehydration, make sure to consume enough hydrating and electrolyte-rich foods and drinks each day. (If your pee is light yellow, you’re on the right track, according to the Mayo Clinic.) Adjust your intake as necessary to account for things like hot weather, exercise and chronic illnesses that can influence hydration levels, such as Crohn’s disease.
You’re sensitive to certain foods
Food sensitivities can cause heart palpitations by triggering an inflammatory response in the body.
“When the immune system identifies a particular food as a threat, it releases histamine and other inflammatory chemicals that can cause the blood vessels to relax and the heart to beat faster and stronger,” Dabhadkar said.
For some ― especially those with low blood sugar ― high-carb or sugar foods can trigger palpitations, Govil said. Other common triggers include high sodium and spicy foods.
Keeping a journal of your food intake and any accompanying symptoms for a period of one to two weeks might help you narrow down the potential culprits. You can then try a process of elimination and reintroduction — where you remove the suspected food for a period of time and then reintroduce it — to see how doing so aligns with when your palpitations strike.
If your heart palpitations make a comeback when a specific food is reintroduced, chopping it from your diet can help alleviate symptoms.
You’re taking a new medication or supplement
Initiating or taking new doses of medications such as beta blockers, thyroid medications and inhalers can elevate your heart rate and trigger palpitations. The same goes for over-the-counter cold medications — especially those that contain decongestants, Govil said.
If your palpitations started just after a new or adjusted medication or supplement, talk to your doctor or pharmacist about your symptoms to figure out the best course of action, such as possible alternatives to what you’re taking.
You’re sleep-deprived
Sleep deprivation can cause palpitations by affecting the heart’s electrical activity.
“The lack of sleep can lead to an increase in stress hormones, such as cortisol and adrenaline, which can disrupt the normal rhythm of the heart and cause it to beat faster or irregularly,” Dabhadkar said. “Sleep deprivation can also lead to changes in blood pressure, which can further contribute to palpitations.”
To prevent palpitation episodes caused by sleep deprivation, fine-tuning your sleep habits is paramount. This might include sticking to a consistent sleep schedule, avoiding stimulating activities before bed and cozying up your bedroom environment so it encourages feelings of calm (and, well, sleepiness).
If you do all of this but still experience heart palpitations, and also experience other symptoms like daytime fatigue, morning headaches, difficulty concentrating, and irritability, you might want to get tested for sleep apnea — a disorder that causes your breathing to repeatedly stop and start throughout the night.
“If the apnea episodes are long enough, oxygen levels in the blood can decrease and cause ischemia, or direct damage to the heart cells,” Govil said.
“This can cause palpitations, as well as arrhythmias (heart rhythm disorders).”
Your blood sugar is low
Glucose is the primary source of energy for the body’s cells. “When blood sugar levels drop, the body releases adrenaline in an attempt to raise them, which can cause the heart to beat faster and stronger, resulting in palpitations,” Dabhadkar said.
This can be prevented by eating regularly and evenly throughout the day, making sure that each meal and snack includes a balance of complex carbs, proteins and fats — especially important for diabetics on insulin or other sugar-lowering medications.
Your hormones are out-of-whack
Hormonal fluctuations can cause heart palpitations ― say, during premenstrual syndrome, pregnancy or menopause.
The increase in estrogen and progesterone during PMS, for instance, can cause an increase in heart rate and blood flow, leading to feelings of fluttering or racing in the chest, Dabhadkar said.
Pregnancy palpitations are usually due to a combination of hormone level increases, changes in blood volume and an uptick in the heart’s workload that can cause it to beat faster or irregularly.
Meanwhile, the risk of heart palpitations increases when estrogen levels decrease during menopause (the hormone is thought to be protective of heart health by keeping cholesterol in check, among other skills).
“People who are concerned about hormone-related arrhythmias should see a physician to determine if a heart monitor, and subsequently any therapy, such as beta blockers, is needed,” Govil said.
You’re low on iron
Anemia ― a lack of sufficient red blood cells in the body ― means the blood can’t carry as much oxygen to your body’s organs and tissue.
“The body sends signals back to the brain, which in turn tells the heart to speed up to provide the needed blood flow,” Govil said. “The increase in heart rate is felt as palpitations.” Other symptoms of anemia can include fatigue, weakness and shortness of breath.
Because anemia can be caused by a multitude of underlying conditions, getting the appropriate work-up with your doctor is needed to find the right treatment. “A common cause for anemia, especially in premenopausal people, is iron deficiency, which can often be taken care of with iron supplements,” Govil said.
Depending on the underlying cause, there are also medications available that increase the production of red blood cells — and in severe cases, blood transfusions can be an option. Bottom line: Treating the underlying condition will also treat the anemia.
You drink alcohol
Alcohol can lead to palpitations by causing a one-two punch of changes in the electrical activity of the heart and excessive blood vessel relaxation (more clinically known as vasodilation). The result: a higher heart rate and stronger heartbeats.
Getting your drink on can also cause dehydration and inflammation, which can exacerbate symptoms, Dabhadkar said. It can also impact sleep quantity and quality if nightcaps are more your thing.
To top it off, research suggests that even light amounts of alcohol can trigger arrhythmias in some people, especially if they’re already predisposed to heart rhythm disorders. That can include atrial fibrillation, or AFib, a common type of abnormal heartbeat. Reducing your alcohol intake — setting limits on when and how much you drink, or going dry — can help decrease the chance of heart palpitations and abnormal heart rhythms.
Your thyroid is acting up
One of the effects of hyperthyroidism (overactive thyroid) is it can speed up your heart rate and even cause abnormal rhythms. Other symptoms can include weight loss without trying, depression, period changes and feeling weak or tired.
“Anti-thyroid medications can block the overproduction of thyroid hormone and help reduce symptoms,” Govil said. “Some patients may also need beta blocker medications to reduce heart rate.” If meds alone aren’t enough to reduce excessive hormone levels, surgery may be required to partially or completely remove the thyroid.
You’ve had COVID
“COVID infections cause myocarditis, which is inflammation of the heart muscle,” said Dr. Robert S. Fishel, a Florida-based board-certified cardiologist and electrophysiologist. “This can lead to various heart rhythm disorders, including AFib.”
Anyone who’s been infected with COVID (even a mild case), is at a substantial risk of experiencing persistent heart issues long after the infection has passed, according to research published in the journal Nature Medicine in February 2022.
“Treatment for palpitations and abnormal heart rhythms is tailored to a patient’s specific symptoms and requires a work-up be done to figure out the best therapy,” Govil said.
Your blood pressure needs work
Postural orthostatic tachycardia syndrome (POTS) is a condition in which your heart rate increases significantly upon standing, resulting in heart palpitations, lightheadedness and fainting. It’s most common in people 15-50 years old and assigned female at birth, according to the Cleveland Clinic.
“The exact cause of POTS isn’t well understood, but it’s thought to be related to problems with the autonomic nervous system, which controls the body’s automatic functions, like heart rate and blood pressure,” Dabhadkar said.
POTS can strike following a viral illness (think: mono or COVID) and people with certain autoimmune conditions, including lupus and celiac disease, are more likely to develop it. Fortunately, there are plenty of lifestyle modifications that can alleviate the severity of POTS symptoms, all of which involve keeping your blood pressure elevated: increasing your salt intake, staying hydrated, eating smaller meals more often, wearing compression stockings and practicing isometric exercises, to name a few. Medications are also available to help with increasing blood volume.
You’re in crash mode
One of the hallmark symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) — and now, long COVID — is something called post-exertional malaise, or PEM.
Post-exertional malaise causes a person to experience “crashes” — a delayed worsening of symptoms roughly 24-72 hours after even the mildest physical or mental exertion. One possible symptom is heart palpitations. Depending on the crash, post-exertional malaise can go so far as to leave a person bed-bound for weeks.
Unfortunately, ME/CFS is one of the most misunderstood and neglected illnesses out there, with long COVID not far behind. For now, the only option available to break this cycle of overexertion is pacing yourself. Find your energy envelope ― the pace at which you can do things without triggering post-exertional malaise ― and do your absolute best to keep your daily grind within this window.
These symptom questionnaires from DePaul College of Science and Health might be helpful for tracking your ME/CFS, long COVID and post-exertional malaise crashes over the long term.
Signs you should see a doctor about your heart palpitations
You should touch base with your doctor if the heart palpitations you experience aren’t just the occasional blip ― they happen on a recurring basis and the episodes last for more than a few seconds at a time.
“You should see a doctor right away if your palpitations are associated with other symptoms, such as severe lightheadedness, dizziness, shortness of breath, chest pain, fatigue and passing out,” Govil said. Ditto if you have a family history of heart rhythm disorders or a relative who experienced sudden cardiac arrest.
The underlying cause of your heart palpitations can sometimes reveal itself during the consultation process without any testing. But in many cases, you’ll need to wear a heart monitor for up to a few weeks so your doctor can figure out whether your palpitations are due to an arrhythmia that needs further treatment.
“If required, your doctor will probably start with prescribing a medication, and it may take a few tries to find the right medication and dosage to help your symptoms,” Govil said. And should an abnormal rhythm show up during your time on a heart monitor, you may need additional tests or procedures to get your beats back on the rails.