Should I worry if my heart skips a beat?

Many of us have felt it on one occasion or another — a fluttering sensation in our heart, perhaps some palpitations, even a heavy pounding in our chest. What's the cause and when is there reason to be concerned?

"Most people, at some point in their lives, experience these symptoms," says Maribel Hernandez, MD, medical director of the Women's Heart Initiative at Main Line Health, and former American Heart Association Go Red for Women Heart Champion. "Much of the time, symptoms are brief and benign. The time to worry is when symptoms are sustained and/or if they are accompanied by lightheadedness, chest pain or shortness of breath."

Causes of heart arrhythmias

Dr. Hernandez, who is board-certified in electrophysiology and cardiology, explains that there are several common causes for these sensations, known as heart arrhythmias. Arrhythmias occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly.

There are several possible causes for arrhythmias, including:

Medical conditions

An overactive thyroid is one of the conditions that may lead to heart rhythm problems which can be diagnosed and treated. Physicians will also check blood counts to rule out anemia or infection, and to measure the levels of certain chemicals such as magnesium and potassium, which may also cause rhythm problems.

Emotional or physical stress

Physical stress could be caused by an illness, such as a viral infection, pneumonia, bronchitis or recovery following surgery. In times of significant emotional stress, the body's response is to release adrenaline, which can also cause an irregular heartbeat.

Excessive use of alcohol or caffeine

The excessive use of alcohol can cause heart arrhythmias, including atrial fibrillation, that can potentially lead to stroke. An excessive caffeine intake from coffee and soda may cause rhythm problems as well.

Hormonal changes

For some women, hormonal changes during pregnancy or perimenopause can create heart arrhythmias.

"When arrhythmias occur infrequently, they typically don't damage the heart," says Dr. Hernandez. "The time for concern is when arrhythmias are prolonged or cause symptoms. This may signal a more serious cardiac condition—perhaps a leaky valve, weak heart muscle or a problem with the electrical fibers of the heart such as atrial fibrillation or long QT syndrome."

What to do if you think you have an arrhythmia

Dr. Hernandez cautions that several of her patients assumed or were told that the fluttering or pounding they were experiencing regularly was due to anxiety or panic attacks. But upon her evaluation, she was able to identify electrical problems in the heart's circuitry.

"If you have concerns, start by talking with your primary care physician," says Dr. Hernandez. "If you feel you're not being heard, seek an evaluation from a cardiologist or a specialist in arrhythmias. I see many patients, especially women, who have been prescribed medication for anxiety when the cause of their symptoms is actually an arrhythmia."

Diagnostic testing can include electrocardiograms, echocardiograms, stress tests and event monitors that document you heartbeat over a longer period of time. If an arrhythmia is detected, numerous treatment options are available, from medications to catheter ablation procedures.

"Many arrhythmias can be easily cured, and some don't require treatment at all," says Dr. Hernandez. "If you have any concerns, seek a thorough evaluation from a cardiologist. And if any episode is accompanied by chest pain or trouble breathing or you feel like you might faint, call 911."

Next steps:

Make an appointment with Maribel Hernandez, MD
Learn more about Main Line Health's arrhythmia (heart rhythm disorders) specialists
Sudden cardiac arrest vs. heart attack