Why Do Heart Palpitations (Arrhythmia) Happen? When Is It Dangerous?

Heart palpitations are the sensation that your heart is beating faster, irregularly, or unusually forcefully. While they often stem from innocent causes such as stress, excessive caffeine consumption, or fatigue, they can also be the harbinger of an underlying rhythm disorder (arrhythmia). Particularly if the complaint of "my heart is racing" is accompanied by chest pain, shortness of breath, or dizziness, the situation can reach dangerous levels and requires immediate medical evaluation.

At a Glance

• The sensation of palpitations is usually linked to daily life factors like stress, anxiety, lack of sleep, or consuming too much caffeine.
• Medically known as arrhythmia, it is a disruption in the heart's rhythm caused by a glitch in its electrical system.
• If accompanied by chest pain, shortness of breath, or a feeling of fainting, medical help should be sought without delay.
• Painless and reliable methods such as an ECG, Holter monitor, and echocardiography are used during the diagnostic phase.
• The treatment plan varies depending on the cause of the palpitations, ranging from lifestyle changes to medication or catheter ablation.

What Are Heart Palpitations (Arrhythmia)?

Heart palpitations describe the feeling that your heart is fluttering, skipping a beat, or racing in your chest, neck, or throat. In a healthy adult, the resting heart rate is between 60 and 100 beats per minute. The sinus node, located in the upper right chamber of the heart and acting as a natural pacemaker, generates the electrical signals that ensure the heart contracts regularly. Any malfunction in this electrical system causes the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly (fibrillation); this condition is generally called arrhythmia.

Palpitation complaints are quite common in society and can affect people of all age groups. Most people feel their heart skip a beat or make an extra beat at some point in their lives. Such occasional extrasystoles (premature beats) are usually harmless and do not cause concern in a structurally normal heart. However, if these irregular beats become frequent, last a long time, and affect your daily quality of life, they need to be evaluated for an underlying structural heart disease or a permanent rhythm disorder.

Causes and Risk Factors of Heart Palpitations

When examining the causes of heart palpitations, it becomes clear that the source of the problem is not always the heart itself. Daily lifestyle habits, psychological states, and other systemic diseases can also trigger rhythm disorders. Especially considering the effects of stress and a fast-paced lifestyle on heart health, high anxiety levels—perhaps from navigating the bustling Istanbul traffic—and panic attacks are among the most common external causes. Additionally, consuming excessive amounts of traditional Turkish tea, coffee, or energy drinks, smoking, alcohol intake, and inadequate sleep can stimulate the heart's electrical system and accelerate its rhythm.

Looking at medical and structural causes, an overactive thyroid gland (hyperthyroidism), anemia, low blood sugar, febrile illnesses, and imbalances in electrolytes like potassium and magnesium in the body stand out. Heart-related causes include previous heart attacks, heart failure, heart valve diseases, congenital heart abnormalities, and heart muscle diseases (cardiomyopathy). People with a family history of genetic rhythm disorders are also at a higher risk of developing an arrhythmia.

What Are the Symptoms of Arrhythmia?

Arrhythmia symptoms appear across a wide spectrum depending on the type and severity of the rhythm disorder, as well as the patient's general health. In mild cases, a person may feel no discomfort at all, and the arrhythmia might only be noticed by chance during a routine examination. However, when symptoms do occur, the most common complaint is the sensation of palpitations, which patients often describe as "my heart is racing," "it feels like a bird fluttering in my chest," or "my heart is beating in my throat." This feeling can start suddenly and pass within seconds, or it can last for hours.

In more severe rhythm disorders, the heart's pumping power drops, meaning not enough blood reaches the brain and other organs. At this stage, in addition to palpitations, patients may experience pressure or pain in the chest, shortness of breath, excessive sweating, dizziness, blackouts, and a feeling of lightheadedness. In cases of bradycardia, where the heart rate slows down excessively, constant fatigue, weakness, and a drop in exercise capacity are noticeable. Particularly in older patients, these symptoms are sometimes mistakenly ignored as a natural consequence of aging.

Diagnosis: How Are Palpitations Diagnosed at the Hospital?

When you visit the hospital complaining of palpitations, your doctor will first listen to your medical history and perform a detailed physical examination. An Electrocardiogram (ECG), which records the heart's electrical activity on paper, is the first and most basic test used in diagnosing arrhythmia. However, palpitations may not always occur while you are at the hospital. For this reason, a Holter monitor—which records your heart rhythm for 24 to 48 hours via small electrodes attached to your chest—is frequently preferred. This way, rhythm changes during your daily activities or sleep can be captured.

An echocardiogram (Echo), which uses sound waves to evaluate the heart's structure, the condition of its valves, and its pumping strength, is also performed. If your palpitations are triggered by physical activity, your doctor may request a stress test. During this test, your heart rhythm and blood pressure are continuously monitored while you walk on a treadmill. Furthermore, detailed blood tests (TSH, complete blood count, potassium, etc.) are an integral part of the diagnostic process to rule out thyroid diseases, anemia, or electrolyte imbalances that could cause palpitations.

Treatment: What Helps with Palpitations and Which Methods Are Used at the Hospital?

The main goal of treatment planning is to find the underlying cause of the palpitations and restore the rhythm to normal. Patients frequently ask what helps with palpitations. Lifestyle changes you can make at home are highly effective. Limiting caffeine and alcohol consumption, quitting smoking, getting regular and sufficient sleep, and incorporating stress management techniques like meditation or yoga into your life can significantly reduce palpitation attacks. Moreover, drinking enough water and avoiding heavy, greasy meals also help protect your heart rhythm.

Medical treatments administered at the hospital vary depending on the type of arrhythmia. Beta-blockers or antiarrhythmic drugs may be prescribed to slow down and regulate fast rhythms. In cases where medications are insufficient, a procedure called cardioversion is performed, where a controlled electric shock is delivered to the heart to reset its rhythm. Catheter ablation, which neutralizes the problematic heart tissue causing the rhythm disorder using radiofrequency energy or freezing, can offer a permanent solution. In cases where the heartbeat is dangerously slow, pacemakers placed under the skin ensure the heart beats regularly.

Complications and Risk Groups

Untreated or uncontrolled severe rhythm disorders can lead to life-threatening complications. In particular, an irregular rhythm called atrial fibrillation paves the way for blood to pool in the upper chambers of the heart and form clots. If this clot enters the bloodstream and reaches the brain, it increases the risk of a stroke by about five times. Furthermore, if the heart beats very fast or irregularly for a long time, it can eventually tire the heart muscle, leading to heart failure. The most feared complication is sudden cardiac arrest, where the heart suddenly stops and requires emergency intervention.

Some individuals carry a higher risk of developing an arrhythmia. Advanced age (especially over 60), high blood pressure, diabetes, obesity, and sleep apnea syndrome are major factors that strain the heart's structure and electrical system. Patients who have previously had a heart attack, have coronary artery disease, or have undergone heart valve surgery are also in the risk group. It is of great importance for individuals with a family history of unexplained sudden cardiac arrest at a young age to have regular cardiology check-ups, even if they have no complaints.

When to See a Doctor and When Is It Dangerous?

The sensation of palpitations usually lasts for a few seconds and passes on its own. However, if this condition becomes continuous or occurs alongside specific warning signs, it means alarm bells are ringing. If your palpitations start suddenly while you are resting, last for minutes, and prevent you from doing your daily tasks, you must be examined by a cardiology specialist. Early diagnosis is the most crucial step to stop the progression of potential serious heart diseases.

If you experience any of the following symptoms along with palpitations, you should call 112 for emergency services without delay or go to the nearest hospital's emergency department:

• Severe pain, pressure, or a squeezing sensation in your chest, left arm, back, or jaw.
• Sudden shortness of breath that makes it difficult to breathe.
• Blackouts, severe dizziness, or sudden fainting (syncope).
• Cold sweats and a feeling of extreme weakness.

The Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Cardiology department, the diagnosis and treatment of heart rhythm disorders are carried out at international standards with a modern technological infrastructure. As a JCI-accredited private hospital located in Küçükçekmece, Istanbul, our expert physicians perform a detailed evaluation when you present with palpitation complaints and plan necessary tests such as ECG, echocardiography, and Holter monitoring. Our hospital is equipped with a 24/7 emergency department ready to instantly intervene in sudden rhythm disorders and heart attacks.

When coming to your appointment, bringing along any previous ECG results, Holter reports, and a list of medications you use regularly will speed up the diagnostic process. During the treatment phase, all procedures—from medication adjustments and wrist angiography to catheter ablation and pacemaker implantation—are safely performed by our experienced cardiology team. You can call our contact center or use our website to reach our hospital and book an appointment.

Frequently Asked Questions

Can heart palpitations be psychological?

Yes, psychological conditions such as intense stress, anxiety disorders, and panic attacks are among the most common causes of heart palpitations. When the body is under stress, it releases adrenaline, which causes the heart to beat faster and stronger.

What should I do at home during a palpitation?

When you feel palpitations, first try to calm down, sit, or lie down. Take deep, slow breaths, splash cold water on your face, or drink a glass of cold water. If your complaints do not pass within a few minutes or if chest pain is added, call for emergency medical help.

Does drinking coffee cause rhythm disorders?

The caffeine in coffee is a substance that can stimulate the heart's electrical system. While 1-2 cups of coffee a day generally do not cause problems in healthy individuals, excessive consumption or drinking it if you are sensitive to caffeine can cause palpitations and extrasystoles (premature beats).

Why do heart palpitations happen at night while sleeping?

Nighttime palpitations usually occur due to the accumulation of daytime stress, late-night tea or coffee consumption, heavy dinners, or sleep apnea. Additionally, lying down brings the heart closer to the rib cage, which can make even normal beats feel like palpitations.

If an ECG is normal, can we say there is no arrhythmia?

No, an ECG only shows the heart rhythm during the few seconds it is being recorded. Because arrhythmias usually occur intermittently, even if the ECG is normal, longer-term recording devices like a 24 or 48-hour Holter monitor are needed if your complaints persist.

We wish you healthy days. To ensure your heart health is not left to chance and for a detailed evaluation, you can book an appointment.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.