Heart Palpitations: When to Worry and When to Relax

We understand the sudden jolt of fear that comes when your heart decides to skip a beat or race without warning. Managing a household or running a business is stressful enough without the added anxiety of wondering if your body is failing you.

Heart palpitations account for roughly 16% of all primary care visits, so you are certainly not the only one asking these questions.

We see many patients who worry that a fluttering chest signals an impending heart attack, but the data often tells a less scary story. A 2024 study found that while palpitations are alarming, the majority of cases stem from manageable triggers like stress or dehydration rather than life-threatening heart disease.

We want to help you distinguish between a harmless rhythmic blip and a signal that requires professional maintenance. Our heart rhythm disorder specialists will help you understand the real physiological causes, the specific red flags to watch for, and the practical steps to get your rhythm back on track.

What Are Heart Palpitations?

Heart palpitations are simply an increased awareness of your own heartbeat, a phenomenon doctors call “interoception.” Under normal conditions, your heart functions on autopilot, and you don’t feel a thing. The sensation becomes noticeable only when the rhythm changes or the force of the contraction increases.

People describe palpitations in various ways:

• Heart racing or beating too fast
• Heart pounding or beating hard
• Heart fluttering or flip-flopping
• Heart skipping beats or stopping briefly
• Heart beating irregularly

We hear patients describe this sensation as a “thud” in the chest or a feeling like a bird fluttering in the throat. These episodes might last just a few seconds, or they can persist for hours, distracting you from your work and family.

Common Harmless Causes

Most palpitations are benign, meaning they are not harmful to your long-term health. The following triggers are the usual suspects we identify in our clinic.

Stress and Anxiety

Running a company or managing a family budget creates chronic low-level stress that spikes your cortisol and adrenaline. This chemical surge triggers your “fight-or-flight” response, causing your heart to speed up even when you are sitting at your desk. Anxiety attacks can mimic heart issues perfectly, often bringing shortness of breath and chest tightness along for the ride.

Caffeine and Stimulants

We all rely on a morning coffee to get moving, but the dosage matters. The FDA cites 400 milligrams of caffeine (about four cups of coffee) as a safe daily limit for healthy adults, but genetic sensitivity varies wildly. Some people metabolize caffeine slowly, meaning a single afternoon espresso can trigger palpitations hours later.

Lack of Sleep

Sleep deprivation puts your body in a state of physiological stress. Statistics from the CDC indicate that 1 in 3 adults don’t get enough sleep, which directly correlates with increased heart rate variability and palpitations. Your heart needs that downtime to reset its electrical system.

Dehydration and Electrolytes

We often find that simple dehydration is the culprit. When you are dehydrated, your blood volume drops (hypovolemia), forcing your heart to beat faster to circulate oxygen.

Specific nutrient deficiencies also play a massive role.

• Magnesium: Up to 48% of U.S. adults do not consume enough magnesium.
• The Fix: This mineral acts as a natural calcium blocker to help the heart relax.
• Potassium: Low levels can cause muscle cramping and heart irregularity.

Premature Beats

Extra heartbeats called premature ventricular contractions (PVCs) or premature atrial contractions (PACs) are extremely common. They feel like your heart skips a beat, but it is actually adding an early extra one. In structurally normal hearts, a burden of less than 1% of total daily heartbeats is usually considered benign.

When to Be Concerned

While most episodes are harmless, you need to know where the line is. We categorize symptoms into “manageable” and “immediate action required” to help you make quick decisions.

Harmless vs. Warning Signs

Feature	Usually Harmless	Requires Evaluation
Rhythm	Occasional skipped beat	Totally chaotic, irregular rhythm
Duration	Seconds to a few minutes	Lasts for hours or won’t stop
Trigger	Stress, caffeine, exercise	Happens during sleep or rest
Associated Symptoms	Mild anxiety	Fainting, chest pain, shortness of breath

Red Flag Symptoms

Seek immediate medical attention if palpitations are accompanied by:

• Chest pain or pressure (likened to an elephant sitting on your chest)
• Severe shortness of breath
• Dizziness or lightheadedness
• Fainting (syncope) or near-fainting
• Confusion or altered consciousness

Schedule a prompt evaluation if you experience:

• Palpitations that occur frequently
• Episodes lasting several minutes or longer
• Palpitations during rest or waking you from sleep
• Heart rate consistently over 100 beats per minute
• Palpitations with a very irregular pulse
• New palpitations if you have heart disease

Risk Factors for Serious Arrhythmias

Your personal history provides the context for these symptoms. We take palpitations much more seriously if you have a known structural issue.

• History of heart disease: Previous heart attack, heart failure, or cardiomyopathy.
• Family history: Sudden cardiac death in close relatives, especially before age 50.
• Structural heart abnormalities: Valve problems or congenital defects.
• Electrolyte imbalances: Chronic issues with potassium or magnesium absorption.

What Your Doctor Will Do

If you seek evaluation, the goal is to capture the heart’s electrical activity while the symptom is happening. We use advanced monitoring technology that goes far beyond the old-school 10-second EKG.

Take a Detailed History

Expect questions about:

• What the palpitations feel like
• How often they occur and how long they last
• What triggers them
• Associated symptoms
• Caffeine, alcohol, and medication use
• Medical and family history

Perform an Examination

Your doctor will check your pulse, blood pressure, and heart sounds. They will also look for physical signs of thyroid issues (like a swollen neck) or anemia.

Advanced Testing Options

Electrocardiogram (ECG/EKG): This standard test records your heart rhythm at that exact moment. It is useful but limited because it often misses intermittent issues.

Zio Patch vs. Holter Monitor: We often prefer modern adhesive patches over traditional wired monitors. A study involving iRhythm’s Zio Patch showed it had a diagnostic yield nearly 2 times higher than a traditional 24-hour Holter monitor because patients can wear it comfortably for up to 14 days.

Echocardiogram: An ultrasound of the heart. It checks if the structure (valves and chambers) is healthy, ruling out physical defects.

Blood Tests: These check for thyroid function (TSH), electrolyte levels, and blood cell counts to rule out anemia.

Managing Palpitations

Treatment depends entirely on the root cause. We focus on fixing the underlying triggers before moving to medication.

Lifestyle Modifications

For benign palpitations, simple changes yield big results:

• Hydration: Aim for the National Academies’ recommendation of about 3.7 liters of fluids for men and 2.7 liters for women daily.
• Magnesium Intake: Discuss a Magnesium Glycinate supplement with your doctor, as it is easier on the stomach than other forms.
• Stress Management: Try “Box Breathing” (inhale 4 seconds, hold 4, exhale 4, hold 4) to lower cortisol immediately.
• Sleep Hygiene: Protect your 7-8 hours of rest as strictly as you protect your business assets.

The “Modified” Vagal Maneuver

You may have heard of holding your breath to stop a racing heart, but there is a better way. We recommend the “Modified Valsalva Maneuver,” which was proven in the REVERT trial to be significantly more effective (43% success rate vs. 17%).

1. Sit down and blow into a 10mL syringe (or similar resistance) for 15 seconds.
2. Immediately lie flat on your back.
3. Have someone lift your legs to a 45-degree angle for 15 seconds.
4. Return to a sitting position.

Medications and Procedures

If lifestyle changes fail, medical intervention is the next step:

• Beta-blockers: These block the effects of adrenaline, keeping your heart rate low.
• Antiarrhythmic drugs: Specialized medications for specific rhythm disorders.
• Catheter Ablation: A procedure where a specialist cauterizes the tiny area of heart tissue causing the misfire.

Tracking Your Palpitations

Data is your best friend when diagnosing heart issues. We encourage patients to keep a detailed log, as memory can be unreliable during a stressful medical appointment.

Record these details:

• Date and time of episodes
• Duration (be precise)
• Activity level (e.g., “sitting at desk” vs. “lifting boxes”)
• Caffeine/Alcohol intake in the prior 4 hours
• Stress level (1-10)

Leveraging Wearable Tech: Modern smartwatches are surprisingly accurate tools. A 2024 meta-analysis found that the Apple Watch ECG feature has a sensitivity of roughly 94% and a specificity of 95% for detecting Atrial Fibrillation. If your watch alerts you to an irregular rhythm, export that PDF and bring it to your appointment—it is valuable clinical data.

The Bottom Line

Palpitations are common and usually harmless, but they shouldn’t always be ignored. If you experience frequent palpitations, palpitations with concerning symptoms, or simply want peace of mind, getting evaluated is worthwhile.

At Los Angeles Heart Specialists, we have the expertise and technology to diagnose the cause of your palpitations accurately. From advanced rhythm monitoring to electrophysiology services, we can determine whether your palpitations are benign or require treatment.

Don’t let palpitations cause unnecessary anxiety. Schedule an evaluation and get the answers you need.