Heart Palpitations: Causes and Concerns

Heart rate issues

Doctor, I would like to ask you about something.
Recently, when I am resting, I sometimes feel like my heart skips a beat, and then it returns to normal, but then suddenly it skips again.
However, when I check my pulse, it feels regular and steady.
I don’t experience this issue when I’m exercising; it only happens when I’m at rest.
Am I being too anxious about my heartbeat? I often worry that my heart might stop at any moment, which frightens me.
Sometimes, when I’m sitting and using my phone, I suddenly feel a skipped beat, and then it goes back to normal.
I had an electrocardiogram in February this year, and it showed no problems.
I would like to know what this could mean, doctor.

che che, 10~19 year old female. Ask Date: 2020/07/25

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive consumption of caffeinated beverages.
If this condition does not improve and becomes more frequent, it is recommended to visit a cardiology clinic for a 24-hour Holter monitor test.

Reply Date: 2020/07/25

More Info

Heart palpitations can be a concerning experience, especially when they occur during periods of rest or relaxation. It's understandable to feel anxious about your heart's rhythm, particularly if you are experiencing sensations of skipped beats or irregularities. Let's delve into the potential causes and concerns surrounding heart palpitations, especially in the context of your situation.

Understanding Heart Palpitations
Heart palpitations are often described as the sensation of feeling your heart beating, fluttering, or skipping a beat. They can occur for various reasons, and while they can be alarming, many cases are benign and not indicative of a serious underlying condition. Common causes of palpitations include:
1. Anxiety and Stress: Emotional stress or anxiety can lead to heightened awareness of your heartbeat. When you are anxious, your body releases stress hormones like adrenaline, which can increase your heart rate and make you more sensitive to changes in your heartbeat.

2. Caffeine and Stimulants: Consumption of caffeine, nicotine, or other stimulants can lead to palpitations. If you consume coffee, energy drinks, or even certain medications, these could be contributing factors.

3. Hormonal Changes: Fluctuations in hormones, such as those experienced during menstruation, pregnancy, or menopause, can also lead to palpitations.

4. Electrolyte Imbalances: Low levels of potassium, magnesium, or calcium can affect your heart's electrical system and lead to palpitations.

5. Physical Activity: While you mentioned that you do not experience palpitations during exercise, it's worth noting that some individuals may feel palpitations more acutely when at rest, particularly if they are hyper-aware of their body.

6. Underlying Heart Conditions: Although your recent ECG was normal, it’s important to consider that structural heart issues or arrhythmias can sometimes present with palpitations. Conditions like atrial fibrillation or premature ventricular contractions (PVCs) may not always be detected unless monitored over a longer period.

Your Experience
In your case, the fact that you are feeling these palpitations primarily while at rest and not during physical activity is significant. It suggests that your body may be reacting to stress or anxiety rather than a direct cardiac issue. The regularity of your pulse when you check it is reassuring, as it indicates that your heart is functioning normally at that moment.

It's also common for individuals to become hyper-aware of their heartbeats, especially if they are anxious about their health. This heightened awareness can create a cycle of worry, where the fear of experiencing a skipped beat can, in itself, lead to increased anxiety and further palpitations.

Recommendations
1. Monitor Your Symptoms: Keep a diary of when you experience these palpitations, noting any associated activities, stress levels, or dietary factors. This can help identify potential triggers.

2. Relaxation Techniques: Consider incorporating relaxation techniques such as deep breathing, meditation, or yoga into your routine. These can help manage anxiety and reduce the frequency of palpitations.

3. Limit Stimulants: If you consume caffeine or other stimulants, consider reducing your intake to see if it has an effect on your symptoms.

4. Follow Up with Your Doctor: Since you have already had an ECG that was normal, it may be beneficial to discuss your symptoms further with your healthcare provider. They may recommend a Holter monitor to assess your heart rhythm over a longer period, especially if your symptoms persist or worsen.

5. Stay Informed: Educate yourself about heart health and anxiety management. Understanding your body and its responses can help reduce fear and anxiety surrounding palpitations.

Conclusion
While heart palpitations can be concerning, many cases are benign and related to anxiety or lifestyle factors. It's essential to stay calm and monitor your symptoms, and if they persist or cause significant distress, seek further evaluation from your healthcare provider. Remember, you are not alone in experiencing these sensations, and with the right approach, you can manage your concerns effectively.

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