Having heart palpitations, should I be worried?
August 26, 2014 3:54 PM   Subscribe

Having prolonged heart palpitations, yes I will see a doctor but what tests should I ask for? I've tried to stay off of Google because it's going to convince me I'm dying of heart failure, but how common is this? Should I be concerned?

Thankfully I don't need referrals to see a specialist so I'm going to make an appointment as soon as I do a little research for a competent doctor. Should I see a cardiologist? I occasionally get heart palpitations that last for a few minutes and just go away. I've never had them last for as long as they have last night and today. I had some start last night and it lasted for hours. And it started up again today, lasting another few hours. I do have problems with anxiety, but I've had anxiety issues pretty much my whole life and have never had heart palpitations this long, maybe anxiety affects you more as you age? But the heart palpitations today started AFTER a relaxing hour and a half long professional massage.

Relevant information:

-Female, 33 years old, normal BMI
-No blood pressure, cholesterol issues
-On Synthroid for under active thyroid for about a year
-I do drink caffeine, usually one or two cups of coffee in the morning. Occasionally tea in the evenings.
-I don't typically get stressed out but I do have anxiety issues
posted by MaryDellamorte to Health & Fitness (27 answers total)
Meant to add that I'm not having any dizziness or chest pains.
posted by MaryDellamorte at 3:57 PM on August 26, 2014

This is maybe a long shot, but have you been taking ibuprofen a lot? That can cause heart palpitations, and did, in fact, cause them in me when I'd been taking it too often over a period of time.
posted by hought20 at 4:04 PM on August 26, 2014

Not something you should go to a specialist for right away. Go see your regular primary care doctor. Let him or her advise you as to next steps. That's what your PCP is for!
posted by killdevil at 4:05 PM on August 26, 2014 [1 favorite]

Pregnancy can cause them, too, but I assume you would have mentioned that.
posted by hought20 at 4:05 PM on August 26, 2014

Are you having chest pain? Chest pressure? Chest discomfort? Nausea? Abdominal discomfort? Are you short of breath? Dizzy? Light-headed? Do you have numbness or tingling in your left arm? Numbness or tingling in your jaw?

If you answer yes to any of those questions, you need to go to the emergency room.

More questions:
How fast is your resting pulse? Is it regular or irregular?
Does anything precipitate the palpitations?
What other meds do you take?
When was your synthroid last adjusted?
Are you adequately hydrated?
posted by brevator at 4:07 PM on August 26, 2014 [1 favorite]

If your Synthroid isn't at the correct level and is too high, it can cause palpitations. I don't take Synthroid, but I get palpitations when my potassium and magnesium are too low. I either take supplements or drink Electromix drink mix packets (I get them at Whole Foods).

Talk to your doctor about getting your thyroid levels checked and also have them eliminate other possibilities.
posted by quince at 4:10 PM on August 26, 2014 [2 favorites]

IANAD, but this sounds like me a couple of years ago. I have had palpitations for years, mostly when anxious or over-exhausted, but occasionally for no reason at all. Like you, no dizziness or shortness of breath, just the weird sensations in my chest. And then one day it was all day, every day. For me, it was linked to using antihistamines with decongestants (which are steroids--I had no idea). I stopped taking the decongestants and a few days later the palpitations went away.

I went to my PCP and told her my symptoms. The first thing she checked was my thyroid because thyroid problems can often cause palpitations. I had two blood tests (IIRC my PCP suspected hyperthyroidism) and when those came back clear, she sent me to a cardiologist. The cardiologist told me to stop the decongestants and the immediate problem went away. But she did do an echocardiogram and sent me home with an event monitor to be sure. I really appreciated her doing those tests even though she really wasn't worried at all based on my symptoms, so even if your palpitations go away you may consider going through the tests anyway for peace of mind.
posted by Swiss Meringue Buttercream at 4:15 PM on August 26, 2014 [1 favorite]

I don't have a PCP. When I have a regular illness, I go to Patient First but they usually aren't very good with any kind of specialty diagnoses. Definitely not pregnant. I do take Ibuprofen on a regularish basis but not every day. Been taking Aleve the last few days because it's the only thing that helps with my period cramps.

To answer brevator:

Thankfully I'm not having any of the serious symptoms you first listed.

How fast is your resting pulse? Is it regular or irregular? Not sure. I had my resting pulse checked by my thyroid doctor a few weeks ago and he said it was fine.
Does anything precipitate the palpitations? Nothing sticks out in my mind.
What other meds do you take? B12, Vitamin D, Biotin and Iron supplements.
When was your synthroid last adjusted? 4 - 5 months ago. I see my thyroid doctor every 3 - 4 months and just saw him a few weeks ago.
Are you adequately hydrated? Probably not.
posted by MaryDellamorte at 4:16 PM on August 26, 2014

Have you, by chance, changed brands for your thyroid replacement? It's not uncommon to need a slightly different dose from one brand to another. For example, I was on Levoxyl for years and always did fine on a 175 mcg dose, but when there started to be shortages in manufacturing it, the pharmacy switched me to Levothroid at the same dosage, and I had heart palpitations for a week until they got Levoxyl back in stock. (Ditto on Synthroid; I switched to it last year once it was clear the Levoxyl shortages weren't going to be resolved, and my doctor had to bring me down to 150.)

Aside from the thyroid-related heart stuff, I also have mitral-valve prolapse, so I get basic cardiac workups fairly regularly. An EKG is the first thing you'll want done; it can be performed in any doctor's office and takes only a couple of minutes. Depending on what the EKG does or doesn't show, an echocardiogram and/or stress test might be the next steps. You might be referred to see a cardiologist first, or you might be referred to a facility where these tests are performed by technicians, with a cardiologist interpreting the results (after which you may or may not see a cardiologist directly).

In the meantime, definitely try to stay hydrated!
posted by scody at 4:24 PM on August 26, 2014 [1 favorite]

Is there any way you could get a PCP? I know that's sometimes like asking if you can get a pot of gold, but for these kinds of things it's really useful to have someone who can refer you to the right person. You could need a cardiologist, an endocrinologist, or an internal medicine practice could help you without needing a specialist visit.

I will say that I have mildly funky heart stuff and a family history of such, and caffeine is a no-go for me. It has gotten worse as I've gotten older. So to me the obvious first thing before seeing a cardiologist would be to cut the caffeine (sorry!). Next I'd go to the person who prescribed the synthroid. Cardiologist would be pretty far down the list. Again, though, I think a PCP is best. You could have some totally weird symptom that we don't know about that would mean you needed to see someone completely different.
posted by the young rope-rider at 4:26 PM on August 26, 2014

Check your pulse when the palpitations occur. (count for 15 seconds and multiply by 4, or, if it's irregular count for a whole minute). If it is irregular, I would recommend the emergency department. If you are sustaining resting heart rates higher than 140ish that I'd go to the ED. Otherwise, you're probably fine to wait to see a doc. Drink more water, or something with electrolytes in it like gatorade. Also, you should probably get a GP.
posted by brevator at 4:28 PM on August 26, 2014

Is there a reason why you don't have a PCP? Seems odd if you have insurance that would encourage you to see only specialists and discourage having an actual primary care physician to coordinate your care.

I don't mean to come off as flip, but this isn't the sort of problem where you should have to ask your doctor to give you certain tests. This is basic stuff that your doctor should see on a regular basis and know exactly how to approach. The most obvious issue would be your thyroid (or use of caffeine or other over the counter supplement type things that have substances in them to make your heart rate fast) - which certainly wouldn't take a cardiologist to diagnose, but if initial blood work/EKG doesn't turn up the cause, a cardiology referral likely makes sense.
posted by treehorn+bunny at 4:28 PM on August 26, 2014 [3 favorites]

My boyfriend had heart issues (premature ventricular contractions, or PVCs) after he'd developed thyroid cancer but BEFORE they'd found it. I'm not saying you have cancer - but the endocrine system can and does mess with one's heart. A good PCP will know this and know what to check.
posted by julthumbscrew at 4:29 PM on August 26, 2014


If my heart were doing something unexpected/weird/unpleasant for hours, I wouldn't wait to see a PCP or a specialist; I would go to the ER.

Far too many women wait to go to the doctor when they're having odd heart symptoms -- because they feel silly, or aren't sure anything is really wrong, or because the sensations that worry them come and go. Don't do that. It's far better to feel silly at the ER than to have something bad happen to you because you downplayed your very real symptoms.

So for my money, if right now you're having palpitations that aren't stopping, you should go to the ER. Period. If you're not having palpitations right now, you should still make an urgent care appointment with your PCP. If you tell them what you've told us, you'll get all the tests you need, probably starting with an EKG. You might also end up wearing something around for 48 hours that monitors your heart's activity.

Anecdotal: My mom had a condition called supraventricular tachycardia (SVT) for many years before she died of something completely unrelated much later in life. It felt like her heart was suddenly racing for no reason. It could last for a few seconds, or for a long time. It was treatable and manageable.

One thing she was taught was to cough a few times, hard, when it started. Other tricks were to massage her own carotid artery, clench her abdominal muscles like she was trying to have a bowel movement, or dunk her face in cold water. These tricks were meant to increase the tone of the vagus nerve on the heart and break the abnormal electrical circuit causing the SVT. If it didn't work and the racing continued, she was instructed to go to the ER, where they could keep an eye on her and treat her.

TLDR, you don't need to be in danger of immediate death to go to the ER. You don't need to have something fatal to go to the ER. You don't need to have heart failure or heart disease to go to the ER. If you go to the ER and subsequently fail to die, no one will laugh at you for having gone to the ER.
posted by kythuen at 4:39 PM on August 26, 2014 [4 favorites]

To expand on what others have said, the palpitations you are describing are an extremely common presenting complaint in primary care doctors' offices. Most everyone practicing general internal or family medicine will know how to "work you up" for this problem -- which tests to get and what to do if they're not normal. More broadly speaking, you really need a primary care doctor to coordinate your care, and if you have the sort of insurance that will let you see specialists à la carte, you will certainly be able to find a good in-network PCP.
posted by killdevil at 4:39 PM on August 26, 2014

I know I should have a good PCP but the reason I don't have one now is because I've had a pretty piss poor history with dismissive PCPs. The last one I had was dismissive with my symptoms before I was diagnosed with a thyroid disorder. She told me my thyroid was fine when in fact it wasn't. I found a thyroid specialist on my own and he diagnosed me with an under active thyroid.
posted by MaryDellamorte at 4:40 PM on August 26, 2014

Years ago I had occasional, distressing intervals of irregular (in both frequency and amplitude) heartbeat and the doctor made me undergo a stress test. From the results, he diagnosed the above-mentioned PVC. He said he could give me something to treat this symptom, but the cause was stimulants. Yes, at that time I was drinking a lot of coffee. The solution was to become decaffeinated, which was difficult, but afterwards my PVCs went away. Of course, YMMV.
posted by Rash at 4:59 PM on August 26, 2014

I don't take Synthroid, but I get palpitations when my potassium and magnesium are too low.

I had a scary heart palpitation issue last summer and it was because my potassium was too high. I'd been taking vitamins and eating a lot of carrots and green beans and squash and then exercising a lot so I was dehydrated and overpotassiumed. I went to one of those doc-in-the-box places (after calling the number my health insurance has, they both suggested this and said that place would take my insurance but be sure to find a place that has an EKG) that had an EKG and they did that and gave me a blood test and said that was what they were pretty sure was wrong. They said if it didn't go away in a few days they'd refer me to a cardiologist. It went away. So maybe if you have no PCP you could call the health insurance people and ask them what the best next steps are?
posted by jessamyn at 5:00 PM on August 26, 2014

My husband had what he described as "heart flutters" and after some work ups and monitors and keeping a log, it's likely a gastric thing. He was put on generic Prylosec and it seems to have helped.
posted by PussKillian at 5:23 PM on August 26, 2014

Staying hydrated, as someone above mentioned, is really important. Dehydration can make your heart go haywire.
posted by mareli at 5:42 PM on August 26, 2014

IANAD. Take your pulse using your middle finger on your wrist and a clock with a seconds hand, or your phone with a timer app. I use an app called Instant Heart Rate on my Android. This info will be helpful to your doctor.
Get a very cold, very wet washcloth and put it on your face. Cold water on your face stimulates the mammalian dive reflex, and can reset your heartbeat.
If you know how to do slow, deep, belly breathing, that may help.
Drink a big glass of water - being low on fluids can screw up your electrolyte balance.
Go to the emergency room. I have a type of irregular heartbeat, and if I can't regulate it in an hour, I go to the ER. You've had this for quite a while. If they do their tests while you have the condition, diagnosis is way easier.
posted by theora55 at 7:14 PM on August 26, 2014

Been taking Aleve the last few days

As noted above, NSAIDs like Ibuprofen and Aleve can cause heart palpitations. If you've been taking several doses in a row, it might be that. I can take one does of aspirin, but if I take it every several hours, my eyes puff up (so I don't take it all anymore).

Also, when was the last time you had your iron levels checked? If you are still anemic or having heavy bleeding that can cause it too. Anemia can also mimic anxiety (not saying this is what causes your anxiety, but it certainly can't help).

But, there is no substitute for a live, in-person doctor. If they continue, go to the ER. Bag up all of your meds and supplements, bring a book, and be prepared for an EKG.

IANAD, but if I had heart palps lasting that long, I would go to the ER or walk-in place, depending on time of day. Then I would follow up with whatever type of doctor they recommend.

Or, since you have a relationship with your thyroid doc, call them. Maybe they can refer you to a good PCP who will coordinate treatment after you have been checked out at the ER or clinic.

BTW, you know not to take the iron at the same time as the Synthroid, right? My daughter was on both and she had to take the iron later in the day or at bedtime and the Synthroid in the morning. Something to ask your thyroid doc about, unless you already know this.

It's no fun, I have had heart palpitations before, and I noticed it did happen a lot near my period or during, but doctors poo-poo'd me and my heart checked out fine.
posted by Marie Mon Dieu at 8:41 PM on August 26, 2014 [1 favorite]

The work-up for intermittent palpitations in the absence of dangerous associated symptoms (like chest pain / dizziness / fainting spells / shortness of breath) AND in the absence of a strong family history of premature cardiac death, AND a completely normal physical examination will include some or all of the following:

1. EKG (definitely) to look for tell tale signs of conduction disorders
2. blood tests (checking the thyroid function would be helpful if not done recently but other tests are optional depending on any clues from the physical examination)
3. if your doctor is still not convinced that the palpitations are benign despite the above, a ambulatory EKG may be ordered. It's a device that is strapped on to you for a period of time. It may either continually record your heart rhythm over a 24 hour to 48 hour period or may come with a device for you to trigger the recording when you feel the palpitations coming on.
posted by ianK at 9:26 PM on August 26, 2014

I've just gone through this very thing! I got sick a couple of months back and it triggered tachycardia and pretty bad, recurrent palpitations that would last ALL DAY. I've had them in the past, but these were particularly bad. My doc set me up with an event monitor, and whenever I felt them, I'd push the button to record and then transmit them to the hospital to be interpreted. My doc can't find anything wrong, and the consulting cardiologist said everything is fine. Mine seem to be especially triggered by dehydration. Something that has helped me tremendously is taking a magnesium supplement (always check with your doc before adding supplements if you're taking other medications). So, that's something to look into. Try not to worry. I was told they are extremely common, and totally benign in most cases. I would probably not go straight to a cardiologist. See what your GP thinks first.
posted by I_love_the_rain at 11:30 PM on August 26, 2014

Mine stopped with more magnesium and less calcium.
posted by persona au gratin at 12:52 AM on August 27, 2014

I have this, it's been checked out three times over 7 years (each time was a holter monitor, stress tests and ultrasound) and it is benign. To quote the doctor "sometimes people's hearts do this."

It does last for hours sometimes. It comes and goes - some years many episodes, some not so much.

What stuck out for me in your post was that the most recent one happened after a massage. This points to the vagus nerve which is related to your heart & stomach I believe. When it is stimulated it can result in palpitations. Do you get it if you don't eat for a looong time, and then have something to eat? When I was traveling I would miss meals and then the first bite of food would trigger an attack. Vagus nerve getting worked up. Awful sensation but completely benign.

And yes the cardiologist did recommend dunking my face in cold water to stop it when it started up.

Anyways go see a doctor but don't worry about it too much.
posted by St. Peepsburg at 5:29 AM on August 27, 2014

If you're happy with your thyroid specialist, why not ask him to recommend a PCP?
posted by merejane at 11:02 AM on August 27, 2014 [2 favorites]

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