Every so often, you might feel like your heart skips a beat. It’s called a palpitation, and the beat that follows can feel intense: Think a sharp pain, a quick pressure, or a racing sensation, says Michael Fenster, M.D., an affiliate faculty member at the University of Montana.
For most men, it’s completely normal. But that weird feeling may stop you in your tracks, and if it persists, it may signal something serious.
What Causes a Heart Palpitation
It might sound weird, but heart palpitations usually aren’t sparked by a heart problem. In fact, of people who actually went to the emergency room because of their palpitations, only 34 percent received a cardiac diagnosis, a 2014 study from UCLA found.
More commonly, they’re caused by non-heart triggers like stress, anxiety, fear, or intense exercise.
They do this by increasing your body’s sympathetic tone, which sparks hormonal changes similar to that of your fight-or-flight response, says Dr. Fenster. These can cause palpitations or abnormal rhythms.
And while recent studies have shown that a couple cups of coffee a day won’t set them off, frequent caffeine pills and energy drinks can cause palpitations.
As stimulants, they make your heart beat faster, which can trigger the palpitation feeling.
Think of it this way: “These changes can throw off the natural rhythm of the heartbeat, like a musician who misses or plays a wrong a note as the beat gets faster,” says Dr. Fenster.
Inherited heart conditions and genetics can play a role in how often you feel palpitations, says Dr. Fenster, but often, it simply comes down to statistics.
Considering how many times your heart beats in a lifetime, there are going to be some that are out of rhythm, he explains. (The average heart beats 60 to 100 times per minute which equates to about 52 million times per year.)
When a Heart Palpitation can be Serious
The concern meter depends on two big factors: how often you’re getting them, and how long they last for.
If you’re having short heart palpitations—say, ones that last continuously for less than two or three minutes or ones that come and go during that time span—once a week or less, that’s no reason to rush to the doctor.
But if they’re occurring more frequently than that, make an appointment, Dr. Fenster advises.
Head to the ER for ones that occur with symptoms like chest discomfort, shortness of breath, dizziness, or feeling like you’re about to pass out, says cardiologist Robert Applebaum, M.D., an assistant professor of medicine at the NYU School of Medicine.
The concern with these prolonged or frequent palpitations, with or without symptoms, is that they could be signally a serious arrhythmia, a change in the electrical impulses that govern your heart’s rhythm that results in an abnormal beating pattern, he says.
“We worry about things like atrial fibrillation, where the heart is beating irregularly a lot, which could put someone at risk for stroke,” says Dr. Applebaum.
That’s because when your heart does not produce a regular, strong enough contraction, blood may pool in a chamber of your heart, leading clots. Then, these clots can be pumped to the brain, where they block off blood flow, potentially causing a stroke.
Treating Heart Palpitations
First, your doctor will check to see if there’s a problem with your heart’s beating pattern.
If the cause is a non-cardiac factor, like caffeine pills or stress, treating the underlying issue can ease palpitations, says Dr. Fenster. “The first treatment course would be to simply eliminate any offending or inciting agent, if it can be identified,” he adds.
If not, though, diagnosing heart rhythm issues is relatively easy: He or she can perform an electrocardiogram (also known as an EKG), a heart ultrasound, or hook you up to a Holter monitor to watch your heart’s rhythm for a day or two.
If your doctor does find an arrhythmia, you’ve got two main options. The first line of defense is an anticoagulant medication like Coumadin, which prevents blood clots from forming.
Another route is ablation. This procedure uses a radiofrequency catheter to burn the electrical cabling in the part of the hart that’s interrupting its rhythm, says Dr. Fenster. This allows your heart to beat normally.