Heart palpitations: Identifying possible causes and managing triggers

Do you occasionally feel your heart doing flip-flops when you're stressed or nervous — for example, right before you give a big presentation? These are called heart palpitations. They are very common, but they can feel scary.

Here's a closer look at what heart palpitations are, what they feel like, causes, and, when you might need to worry.

What are heart palpitations?

Have you ever noticed your heart seeming to beat more forcefully or faster than usual? This is known as heart palpitations. They happen to a lot of people — in fact, they are one of the top reasons people see their primary care provider or even a cardiologist.

Heart palpitations may feel uncomfortable, but most of the time they're harmless. They should always be checked out by your doctor, however, in case they're being triggered by an underlying medical condition.

What do heart palpitations feel like?

If you have heart palpitations, you may feel like your heart is pounding or racing. You may also feel it not just in your chest, but in your neck. Some people describe a sensation of "flip-flopping" in their chest, where their heart seems to skip a beat.

Some people experience heart palpitations all day. Others just notice heart palpitations at night, during exercise, or in times of stress.

What causes heart palpitations?

There are many different causes of heart palpitations. These include:

Physical stress or strong emotions. Heart palpitations can be brought on by physical stress, such as intense exercise, or a fever. They can be triggered by strong emotions as well. When you are upset, your body releases stress hormones that can affect your heart rate.

Heart conditions. Sometimes heart palpitations are due to an electrical misfire in your heart that causes it to beat quickly or erratically. One of the most common causes is atrial fibrillation, a rapid, irregular heartbeat.

Hormonal changes. Up to 42% of perimenopausal women and 54% of postmenopausal women report that they experience heart palpitations.

Certain substances. Caffeine, alcohol, and nicotine can all trigger heart palpitations.

Metabolic changes. Low blood sugar can lead to heart palpitations. You may also experience them if your body produces too much thyroid hormone, a condition known as hyperthyroidism.

Do you need to worry about heart palpitations?

See your doctor if you have heart palpitations; most of the time, they can find the trigger. The evaluation usually involves a test called an electrocardiogram (ECG) to measure the electrical signals of your heart.

If you have heart palpitations but a normal ECG, your doctor may ask you to wear a heart monitor for a couple of weeks. You push a button on the portable device when you feel a heart palpitation, and that information is sent to your doctor. It can help to pinpoint a cause.

Sometimes, heart palpitations can indicate a heart attack or stroke if they occur along with other symptoms. Call 911 if you also experience:

• shortness of breath
• chest pain or pressure — it may be constant, or it may come and go
• chest discomfort that radiates into your arms, back, stomach, neck, or jaw
• sweating, nausea, or lightheadedness.

Lifestyle changes to prevent heart palpitations

If your heart palpitations aren't due to an underlying medical condition, the following lifestyle changes may help to prevent them or reduce their frequency.

Try vagal maneuvers. These are physical movements you can do to stimulate your vagus nerve, which helps to control your heart rate. Your doctor may recommend that you:

• cough
• hold your breath and bear down, like you are having a bowel movement
• place an ice-cold towel over your face.

Steer clear of certain substances. Limit caffeine, which is found in coffee, tea, certain soft drinks, and even chocolate. Don't have more than one alcoholic beverage per day. More than that can promote palpitations in some people, and it increases the risk of atrial fibrillation. In addition, don't smoke or consume nicotine-containing products.

Tweak your medications. Certain drugs can trigger heart palpitations. These include asthma inhalers and some over-the-counter cough and cold medications. Your doctor may be able to suggest alternatives.

Manage stress. If you are depressed or anxious, your body releases stress hormones that can impact your heart rate. Your doctor may recommend lifestyle changes to help you manage your emotions, such as regular exercise, talk therapy, and relaxation techniques like meditation or yoga.

Medical treatment for heart palpitations

If your palpitations are due to an underlying medical condition such as atrial fibrillation, tachycardia, or hyperthyroidism, your doctor can recommend medication to get that condition under control.