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My Heart is Racing! Should I Be Concerned?

by Bianca Garilli, ND

Introduction

You’re sitting in a relaxing chair at the bookstore with no acute stress or problems, when out of the blue your heart begins to race, flutter, and skip beats. This is not the first time this has happened and you wonder if you might be experiencing a medical emergency. Should you be concerned and call 911, or simply ignore the strange fluttering feelings and continue reading? The answer, as is often the case in medicine: “It depends”. Most likely, though, you are experiencing a common occurrence known as a heart palpitation.1

Heart palpitations can be felt not just in the chest, but often in the throat and neck as well. They may occur during times of activity or while at rest. When experienced for the first time, the flipping and fluttering feeling can be uncomfortable and frightening. However, not all episodes of heart palpitations are dangerous; therefore differentiating those requiring medical intervention from harmless episodes is important.2

What causes heart palpitations?

Heart palpitations can have a myriad of causes. Some individuals will experience heart palpitations due to an underlying medical condition such as a hyperthyroidism or other thyroid disorders, blood sugar dysregulation, anemia, or from a drop in blood pressure.2 Heart palpitations may also show up alongside fever or dehydration and some women will even experience hormonally-driven heart palpitations during menstrual cycles, pregnancy, or menopause.3

In certain cases heart palpitations may, in fact, be a sign of a more emergent or progressive chronic condition as in the case of arrhythmias, a heart attack, heart failure, heart valve disease, or cardiomyopathy.2 Heart palpitations accompanied by fainting, dizziness, shortness of breath, or chest pain should be evaluated right away.3

Many times, however, heart palpitations are not indicative of a chronic illness or acute medical situation, but instead may be provoked by our emotional state such as acute stress, fear, anger, or anxiety.3 Other times, daily activities or habits like consuming too much caffeine or alcohol or using nicotine, energy drinks, or illicit drugs can trigger palpitations.3 Other culprits of palpitations include strenuous exercise, electrolyte imbalance, fatigue, and certain medications and supplements. For example, certain medications may cause heart palpitations as a side effect, including: inhaled corticosteroids and albuterol used for asthma; antibiotics such as azithromycin; over-the-counter decongestants containing pseudoephedrine or phenylephrine typically used for colds and coughs; and serotonin and norepinephrine reuptake inhibitors (SNRIs) prescribed for depression.3-4

Some supplements such as yohimbe and ephedra (which was banned in the US by the FDA in 2004) may also lead to heart palpitations.5 Hawthorn, an herb which has shown benefits in mild-to-moderate heart failure and sometimes used for managing blood pressure, has been shown to occasionally cause heart palpitations in some people depending on the dose and the individual.4,6

What to do about your heart palpitations?

In order to determine the seriousness of your heart palpitations, it’s important to discuss your specific situation with your healthcare provider (HCP), who may decide to order follow-up tests such as blood work, EKG, echocardiogram, or a Holter monitor.3

Steps for reducing or eliminating heart palpitations will depend on whether the underlying cause is a specific medical condition or something more immediately modifiable. Removing or reducing intake of any palpitation-triggering substance is an obvious step in treating this issue.

Are there natural approaches to reduce palpitations?

Lifestyle modifications can help address palpitations caused by environmental inputs such as stress or emotional situations, nutrition, or exercise. A variety of mind/body techniques can help put a dent in the stressors of life; some examples include tai chi, qi gong, yoga, meditation, breathing, prayer, and biofeedback. Balancing electrolytes through healthful nutrition, hydration, and personalized supplementation is also often helpful.

Research indicates that supplementing with CoQ10 or magnesium may provide palpitation relief in some individuals.7-8 One study investigating the effects of CoQ10 on heart failure found that 50 mg/day for 4 weeks led to a reduction in heart palpitations in participants.Another study looked at magnesium’s potential role in reducing symptoms associated with mitral valve prolapse in patients with low serum magnesium. Heart palpitations, along with anxiety, weakness, chest pain, and dyspnea are often seen with mitral valve prolapse. After 5 weeks of daily magnesium supplementation (600 mg/day magnesium carbonate supplement given TID the 1st week and BID in weeks 2-5), participants reported a significant reduction in all mitral valve-associated symptoms, including heart palpitations.8

In some cases, heart palpitations may be triggered by certain foods, in particular foods with monosodium glutamate (MSG), nitrates, or too much sodium. In these cases, considering an elimination diet or keeping a food journal may help determine which foods are exacerbating the condition.3

In many situations, heart palpitations are not serious and will go away on their own. Be sure to check with your HCP to discuss your individual experiences and concerns you may have.

Citations

  1. Mayo Clinic. Heart Palpitations. https://www.mayoclinic.org/diseases-conditions/heart-palpitations/symptoms-causes/syc-20373196. Accessed July 16, 2018.
  2. National Heart, Lung and Heart Institute. Heart Palpitations. https://www.nhlbi.nih.gov/health-topics/heart-palpitations. Accessed July 16, 2018.
  3. WebMD. Heart Palpitations. https://www.webmd.com/heart-disease/guide/what-causes-heart-palpitations#1. Accessed July 16, 2018.
  4. WebMD. Which medications might raise my heart rate? https://www.webmd.com/heart/medicines-raise-heart-rate. Accessed July 23, 2018.
  5. Thompson CA. Ephedrine alkaloids banned from dietary supplements. AJHP. 2004;61(8):750-752.
  6. Asher G, Viera A, Weaver M, et al. Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial. BMC Complement Altern Med. 2012;12:26.
  7. Lampertico M et al. Italian multicenter study on the efficacy and safety of coenzyme Q10 as adjuvant therapy in heart failure. Clin Investig. 1993;71(8 Suppl):S129-33.
  8. Lichodziejewska B et al. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. Am J Cardiol. 1997;79(6):768-72.

Bianca Garilli, ND

Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.

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