Heart palpitations, when to visit the ER

By Cristiano Antonino On Feb 28, 2023

About palpitations: ideally, many people barely notice their hearts beating, which is natural. However, any noticeable change in the heartbeat should be concerning, be it slow or fast

Chances are, you’re experiencing what’s usually known as “heart palpitations,” a term for feeling your heart is beating hard, fast or erratically.

Although heart palpitations can be worrisome, they are usually harmless

In rare cases, they can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia) that might require treatment or visit to ER (Mayo Clinic 2017).

What causes heart palpitations?

In general, older people are more likely to have medical conditions that can increase their heart palpitations; however, it can show up in people of any age.

Few of the common causes are as follows:

Strong emotional responses, such as stress, anxiety or panic attacks
Depression
Strenuous exercise
Stimulants, including caffeine, nicotine, cocaine, amphetamines, and cold and cough medications that contain pseudoephedrine
Fever
Hormone changes associated with menstruation, pregnancy or menopause
Too much or too little thyroid hormone (Mayo Clinic 2017)

Diagnosing the cause of heart palpitations

The cause of heart palpitations can be challenging to diagnose, especially when you reach the doctor, and the palpitations don’t occur during your office appointment.

In such cases, the doctor will complete a thorough physical exam to identify a cause and include some questions such as:

What are your daily physical activities?
Are you experiencing emotional stress at home or work?
Have you started or stopped a prescription medication? Changed the dosage?
What over-the-counter medications are you taking?
Do you have any health conditions we have not yet discussed, such as high blood pressure or high cholesterol?

The doctor may refer you to a heart specialist to run some tests which could further diagnose the cause:

Blood tests
Urine tests
Physical tress tests
A recording of the heart’s rhythm for 24 hours using a machine called a Holter monitor
An ultrasound of the heart, or an echocardiogram
An electrocardiogram
A chest X-ray
An electrophysiology study to check your heart’s electrical function
Coronary angiography to check how blood flows through your heart

Treatment for heart palpitations

Heart palpitation treatment depends on your doctor and getting to the root cause of the problem.

In case palpitations are due to lifestyle choices such as smoking or consuming too much caffeine, cutting down or eliminating those substances may help. If it is medication-related palpitations, your doctor may change medicines to see if that will resolve the issue.

Preventing heart palpitations

In case your doctor tells you that treatment isn’t necessary, then here are some recommended steps to decrease your chance of getting palpitations:

Try to identify your triggers so that you can avoid them by keeping a log of your activities, as well as the foods and beverages you eat and noting when you get palpitations
If you’re anxious or stressed, try relaxation exercises, deep breathing, yoga, or tai chi
Limit or stop your intake of caffeine
Don’t smoke or use tobacco products
If medication is causing palpitations, ask your doctor if there are any alternatives
Exercise regularly
Stick to a healthy diet