Heart Palpitations

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What are heart palpitations?

Heart palpitations are the sensation that your heart is pounding, racing, fluttering, or skipping beats. You may feel them in your chest, throat, or neck, and they can occur at rest or during activity. For most people, palpitations are brief and infrequent — but even when harmless, they can be alarming, and in some cases they signal an underlying heart rhythm problem that requires evaluation and treatment.

The critical question is not whether palpitations are uncomfortable — it's what is causing them. Dr. Makam, DO, FACC, at Makam Medical provides a thorough, systematic evaluation to find the answer.

What causes heart palpitations?

The causes of palpitations range from completely benign to clinically significant. Common causes include:

• Benign triggers: Stress, anxiety, caffeine, alcohol, nicotine, dehydration, low blood sugar, strenuous exercise, or certain medications and supplements
• Medical conditions: Anemia, thyroid disorders (both overactive and underactive), electrolyte imbalances, or fever
• Heart rhythm disorders (arrhythmias): Including atrial fibrillation (AFib), atrial flutter, supraventricular tachycardia (SVT), premature atrial contractions (PACs), premature ventricular contractions (PVCs), and ventricular tachycardia
• Structural heart disease: Valve abnormalities, cardiomyopathy, or prior heart damage can all produce arrhythmias and palpitations
• Unknown cause: In some cases, no identifiable cause is found after a complete workup

The most important distinction in evaluating palpitations is whether they originate from a benign source or from an underlying arrhythmia that carries risk — particularly risk of stroke, heart failure, or sudden cardiac death.

When should palpitations be evaluated urgently?

Most palpitations do not require emergency care, but certain features warrant prompt evaluation:

• Palpitations accompanied by chest pain, pressure, or tightness
• Palpitations with dizziness, lightheadedness, or fainting
• Palpitations in a patient with known heart disease or a prior heart attack
• Palpitations that are prolonged, frequent, or getting worse over time
• A family history of sudden cardiac death or inherited arrhythmia syndromes

If palpitations are associated with fainting or chest pain, call 911 or go to the nearest emergency department.

What testing is used to evaluate palpitations?

Because palpitations are often intermittent, capturing the abnormal rhythm on a recording is the key diagnostic challenge. Dr. Makam selects testing based on the frequency and character of your symptoms.

Electrocardiogram (EKG) A 12-lead EKG records the heart's electrical activity at a single point in time. It can identify arrhythmias present at the time of testing, conduction abnormalities, and structural changes that may predispose to rhythm problems.

Holter monitor A portable EKG device worn continuously for 24 to 48 hours — or longer — that records every heartbeat during the monitoring period. Ideal for patients with frequent palpitations.

Extended cardiac event monitor For patients with less frequent palpitations, a longer-term monitor worn for 30 days or more can capture intermittent rhythm disturbances that a Holter monitor might miss.

Echocardiogram An ultrasound imaging test that evaluates the heart's structure and function — assessing valve abnormalities, wall motion, chamber size, and pumping efficiency. Important for identifying structural causes of arrhythmia.

Stress test Measures heart function and rhythm response during exertion. Useful when palpitations are triggered by exercise or when coronary artery disease is suspected as a contributing factor.

What are the treatment options for palpitations?

Treatment is entirely dependent on the underlying cause.

For palpitations driven by lifestyle triggers — caffeine, stress, poor sleep, dehydration — targeted modifications are often sufficient. For palpitations caused by a thyroid disorder, anemia, or electrolyte imbalance, treating the underlying condition typically resolves the symptoms.

For cardiac arrhythmias, treatment options may include:

• Medication: Antiarrhythmic drugs or rate-controlling medications to manage atrial fibrillation, SVT, or frequent ectopic beats
• Anticoagulation: For patients with atrial fibrillation, blood thinners are often necessary to reduce stroke risk — independent of whether symptoms are present
• Catheter ablation referral: For patients with recurrent SVT, AFib, or other arrhythmias, ablation procedures can be curative and may be the most appropriate long-term solution
• ICD evaluation: For patients with high-risk ventricular arrhythmias, device therapy may be indicated

Many patients with palpitations ultimately require no treatment beyond reassurance and monitoring. But the only way to know that with confidence is a proper evaluation.

For palpitation evaluation at our Anaheim or Corona, CA offices, call Makam Medical or request an appointment online today.