Medically reviewed by Nassir Azimi, MD, Susan Kerrigan, MD and Marianne Madsen on January 16, 2023
There are times in a day where I can actually detect my heart beating. Sometimes it’s pounding out of my chest, and other times it’s just a sensation that reminds me that no matter what else I’m doing, I could not function without my heart.
Palpitations are a common term used to describe feelings sensing one’s heart beat. It often reflects an abnormal rapid or irregular heartbeat. People often relate feelings of the heart “fluttering” rapidly, pounding, or skipping beats. Although palpitations can be alarming, the good news is that they are typically benign and harmless. These palpitations often occur within the range of normal. For example, you might exert yourself in a rigorous exercise workout that raises your baseline heart rate as your body responds appropriately to the higher level of intensity.
While some people can feel their normal heart beat and hence sense palpitations. There are many sources of a perceived rapid heart rate or a thumping chest which can include elements of stress, emotions, anxiety, exercise, hormonal changes (menstruation), dietary consumption (caffeine and nicotine), recreational drug use, and/or medications. These are all common triggers that are less likely to be an abnormal heart rhythm or a metabolic disorder such as thyroid disease.
It is not unusual for someone with anxiety to feel their heart racing and even have episodes of a very fast and thunderous pounding in their chest. Many times, a panic attack will actually feel like a heart attack, and it is not always easy to discern whether or not it is the case.
While most palpitations are secondary to an underlying benign state, there are instances where palpitations can result from an underlying primary abnormal heart rhythm or other significant medical condition. The issue then becomes how to decide which palpitations, in fact, warrant medical attention. With the sensation of palpitations, it is important to have a better context to further evaluate the situation. For example, palpitations that last only a few seconds and happen very infrequently typically do not need further evaluation. However, symptoms with increasing frequency and/or duration may be caused by a more serious heart or medical condition. It’s also important to recognize other associated symptoms such as chest pain, shortness of breath, dizziness, lightheadedness, or fainting.
Concerns & Diagnosis
As a result of the pandemic, most patients who have been diagnosed with COVID-19 have recovered completely, although some have had residual and lingering symptoms, such as palpitations. This can possibly be explained by becoming deconditioned during this time, coupled with battling the virus and its limitation on physical activity. However, if such a symptom is a concern or if there are any other associated alarming issues such as shortness of breath, dizziness, chest pains, and/or unusual fatigue, one should seek out additional medical consultation.
Occasionally, palpitations can be the manifestation of an arrhythmia, which is an underlying primary heart rhythm abnormality. These abnormalities are generally classified into rhythms that are too fast (tachycardia), rhythms that are too slow (bradycardia), and even a normal heart rate that varies from the usual rhythm. Understanding how to check your pulse and determine the rate and regularity of your heart beat is logically a very useful assessment in this setting. If you feel that your heart is beating quickly, it is recommended that you should check your own pulse–not something everyone knows how to do properly. Some are taught to check it on their wrist or feel the side of their neck. Checking your pulse when you are without any symptoms will help you feel more comfortable with this skill and get an idea of what is normal. It is essential for healthy living that everyone knows how to check their heart rate and how it fluctuates.
Today there are many significant and helpful tools that can assist with this computation. Wearable detectors with specific workout heart rate recorders as well as smart watches are both able to monitor your pulse and even record ECG tracing. Other tools are the Kardia mobile device that works through a smart-phone app to help record one’s single lead (and even a six lead EKG option is available.) The Apple IWatch has a feature now for heart rate and heart rhythm monitoring.
The average person should have a regular heartbeat, which means that the beats (the pulsing that you feel) are coming at a regular rate. If your pulse is “bounding” (throbbing strongly), that is a marker that your heart is pushing out blood with a strong force. If your pulse is weak or faint, it might suggest low blood pressure. This could be related to multiple causes such as dehydration or merely from just standing quickly, to name a few possible causes. Essentially, the key is to be able to detect if an abnormality in your pulse persists for an extended period of time, such as minutes to hours. That could be considered significant. If you know what your normal pulse is, you’ll be able to detect a change.
In this day and age, everybody should be able to take their own pulse. Using many of the devices at our disposal to help in this process, such as watches, pulse oximeters, or blood pressure cuffs, can help. Assessing your heart rate at home provides an immediate evaluation as to whether or not the information is noteworthy. These resources can help us live a healthy and happy lifestyle by knowing our own heart rhythm.
Written by Brooke Mishkin