Heart Palpitations: Causes, Symptoms, and When to Seek Help

Feeling the heartbeat?

Hello, Doctor.
I'm sorry for the long message, but I'm really anxious and don't know what to do.
About a month ago, around midnight, my heart suddenly started beating very hard, reaching over 90 beats per minute, almost 100 (normally it's 70-80, and 60-70 when lying down).
I didn't have any difficulty breathing, but the pounding was very strong, and I could see my chest visibly moving.
After that, I only felt my heart racing to about 85-90 after eating, but it would return to normal after about 2 hours.
Lately, when I sleep at night, I can always hear my heartbeat and feel it, with my body slightly vibrating in sync with my heartbeat.
When lying on my stomach, I can also feel my stomach pulsing like my heart.
My pulse is generally strong, but I've never felt my heart beating like this before, apart from checking my pulse.
I often have a sensation of something stuck in my throat and feel like my breath gets caught halfway by something in my throat.
I have a more severe anxiety disorder, but I’ve never experienced such prolonged episodes before.
During the pandemic, I became quite depressed from staying at home, and after previously taking anti-anxiety medication, I gained weight up to 95 kg (height 175 cm).
I thought it would be a good time to lose weight, so I started walking briskly for 1-2 hours every day and doing 1000 hula hoop rotations at home.
However, I often feel a strong pulsing sensation between my collarbones in my throat, and after exercising, I can see the pulsation through my skin.
After calming down, I can also feel the beating by gently touching it.
In the last couple of days, I've started to experience chest pain, which sometimes goes away when I change positions.
When I sleep, I always feel like there's something stuck in my neck, and my breasts slightly shake with my heartbeat.
I read online that if a woman has larger breasts, she shouldn't be able to see her heart beating, which makes me even more anxious.
I'm constantly afraid that I might fall asleep and not wake up.
I'm really anxious and can't eat anything.
My family keeps saying I'm overthinking and that there's no need to see a doctor, insisting it's just a change in bodily functions, but I'm still very anxious and worried that something might be wrong with my body.
Please, Doctor, help me...

77, 20~29 year old female. Ask Date: 2021/07/22

Dr. Wu Xueming reply Cardiology

Due to your young age and the absence of chronic diseases, your risk of developing heart disease is low.
Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is advisable to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is still recommended to visit a hospital for an electrocardiogram (ECG) examination.

Reply Date: 2021/07/22

More Info

Understanding heart palpitations can be quite concerning, especially when accompanied by anxiety and other physical sensations. It’s important to recognize that heart palpitations are often benign and can be triggered by a variety of factors, including stress, anxiety, lifestyle choices, and even certain medical conditions.

Causes of Heart Palpitations
1. Anxiety and Stress: Anxiety is a common trigger for palpitations. When you experience anxiety, your body releases stress hormones like adrenaline, which can increase your heart rate and make you more aware of your heartbeat. This can lead to feelings of panic and discomfort, especially at night when you are trying to relax.

2. Physical Activity: Engaging in physical activities, such as brisk walking or exercising, can also cause your heart rate to increase. If you are not used to regular exercise, your heart may respond more dramatically to physical exertion.

3. Diet and Stimulants: Consuming caffeine, nicotine, or other stimulants can lead to increased heart rate and palpitations. Additionally, heavy meals can cause discomfort and may lead to sensations of increased heart activity.

4. Hormonal Changes: Hormonal fluctuations, such as those experienced during menstruation or pregnancy, can also affect heart rhythm and lead to palpitations.

5. Medical Conditions: Certain medical conditions, such as hyperthyroidism, anemia, or electrolyte imbalances, can cause palpitations. It’s essential to rule out these conditions if palpitations are frequent or accompanied by other symptoms.

Symptoms to Watch For
While palpitations can be benign, it’s crucial to be aware of accompanying symptoms that may indicate a more serious condition. These include:
- Chest Pain or Discomfort: If you experience chest pain, especially if it feels like pressure or squeezing, it’s essential to seek medical attention.

- Shortness of Breath: Difficulty breathing or feeling winded during normal activities can be a sign of a heart issue.

- Dizziness or Fainting: Feeling lightheaded or fainting can indicate a drop in blood pressure or other cardiovascular issues.

- Prolonged Palpitations: If palpitations last for an extended period or occur frequently, it’s advisable to consult a healthcare provider.

When to Seek Help
Given your symptoms of increased heart rate, chest pain, and anxiety, it’s important to consult with a healthcare professional. They can perform a thorough evaluation, which may include:
- Electrocardiogram (ECG): This test measures the electrical activity of your heart and can help identify any irregularities.

- Holter Monitor: A portable device that records your heart’s activity over 24 hours or longer to detect any abnormal rhythms.

- Blood Tests: To check for thyroid function, electrolyte levels, and other potential underlying conditions.

Managing Anxiety and Palpitations
1. Lifestyle Modifications: Incorporating regular physical activity, maintaining a balanced diet, and avoiding stimulants can help manage palpitations. Gradually increasing your exercise intensity can also help your body adapt.

2. Stress Management Techniques: Practices such as mindfulness, meditation, and deep-breathing exercises can help reduce anxiety and its physical manifestations.

3. Professional Support: If anxiety is significantly impacting your life, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can be effective in managing anxiety.

4. Medication: In some cases, medication may be necessary to manage anxiety or underlying conditions contributing to palpitations.

Conclusion
While heart palpitations can be alarming, they are often benign, especially in the context of anxiety and lifestyle factors. However, given your symptoms and concerns, it is crucial to seek medical advice to rule out any serious conditions and to discuss your anxiety. Remember, taking proactive steps towards your health and well-being is essential, and you are not alone in this journey.

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