What Causes Heart Palpitations — and Are They Dangerous?

You’re sitting at home at night, maybe watching TV or checking your phone, when suddenly your heart feels weird. 

Maybe it feels like it skipped a beat or added an extra beat. Maybe it feels faster or harder than usual. 

You’re trying not to worry, but it’s your heart, after all, so you’re starting to feel kind of anxious. Plus, you think you saw somewhere that COVID-19 can cause heart palpitations. 

Here’s everything you need to know about heart palpitations — including when they’re a sign of something serious.

What heart palpitations are

Doctors consider a normal heart rate to be 60 to 100 beats per minute. 

In many cases, heart palpitations aren’t actually an increase or decrease in heart rate, says Dr. Melissa Robinson, a cardiac electrophysiologist at the UW Medicine Heart Institute who specializes in treatment of arrhythmias, also known as heart rhythm disorders. 

“Palpitations can present as simply a heightened awareness of your heartbeat. The issue is whether or not they represent an arrhythmia,” she explains.

That heightened awareness means you may perceive a change in your heartbeat that is actually normal and doesn’t signify any underlying health issues. Since most of us don’t go about our days hyper-aware of what our heartbeats feel like, just the act of noticing them can cause alarm. 

However, sometimes heart palpitations are actually from an arrhythmia where the heart beats faster or slower than normal, follows an irregular pattern or has extra beats. 

Arrhythmias are something to watch for because they may point to an underlying medical condition and may mean there is an increased risk of stroke or other cardiac events down the road.

“About 50% of the time when people go to a doctor it ends up being normal rhythm, 20% of the time it’s extra beats, and the remaining 30% are actual arrhythmias,” Robinson says. 

It’s also important to note that these percentages vary according to different demographics. Older adults, for example, are more likely to have an actual arrhythmia.

Does COVID-19 cause heart palpitations?

The short answer is yes. The more accurate answer is: it probably won’t happen to you.

That’s because, so far at least, most people who get palpitations and are sick with COVID-19 have already been hospitalized, Robinson says.

According to her, about a third of COVID-19 patients who are hospitalized also incur some level of damage to their heart muscles, meaning they aren’t just having benign heart palpitations but they actually have developed an arrhythmia. 

Unfortunately, that damage means that they could be at risk for serious heart problems in the future. 

“The general public doesn’t need to screen themselves for palpitations to see if they have COVID,” Robinson says.

What heart palpitations feel like

Everyone feels palpitations differently, according to Robinson. For some people, their heart may feel like it’s beating faster or stronger; for others, it may feel like it’s flip-flopping or skipping a beat. 

“Some people describe it as a salmon flipping around in their chest,” Robinson says.

It’s more common to feel palpitations at night when the body is at rest, especially if someone is lying down on their left side, which brings the heart closer to the chest wall.

“A change in rhythm can resonate more and use the chest and the chest wall as a drum,” Robinson explains.

Feeling palpitations during exercise is also common. Less common is feeling them during mild activity, like walking or cleaning around the house. 

What causes heart palpitations

There are many things that can cause your heart to feel a little off, some of which are mild and a few of which are more serious.

There’s a laundry list of things that can cause palpitations: Dehydration, drinking too much caffeine or alcohol, smoking or using drugs (including marijuana), exercising, or having a fever or respiratory illness. And, of course, anxiety. 

Palpitations caused by anxiety are often accompanied by other anxiety symptoms, such as a sense of impending doom, stomach upset, feeling tired and having trouble sleeping, and even trembling or sweating. (And yes, this can sometimes be hard to tell apart from heart problems.) 

While anxiety alone can cause palpitations, Robinson stresses that dismissing palpitations as a symptom of anxiety without an exam or further testing is a bad idea. If you go to a doctor and they don’t take your symptoms seriously, it’s a good idea to advocate for yourself and get a second opinion.

“I see patients, often who tend to be from a marginalized group, who have been told they have anxiety and that’s the issue but they’ve actually had a rhythm problem for decades,” Robinson says. 

This is where it gets tricky: Anything that can cause not-dangerous palpitations can also trigger an arrhythmia. Some underlying causes of arrhythmia are usually harmless, like an extra electrical pathway in the heart that causes a fast heart rate, but others are more serious, such as heart disease or diabetes. 

Do you have an arrhythmia?

The only way to know for sure if you have an arrhythmia or not is to talk with a doctor or try wearing a heart monitor (more on that shortly). However, there are other signs of arrhythmias that you can watch for.

If your heartbeat changes suddenly, if the palpitations are persistent and recurring or severe enough to stop you in your tracks, those are all signs that you have an arrhythmia, Robinson says.

Additionally, you may notice an irregular pattern to your heartbeat, rather than it simply feeling faster or harder. Your heart may beat irregularly when you bend over, have something cold to drink or after you eat a large meal, and when the irregularity starts you may feel like you have a frog in your throat.

“It has to do with a top chamber of the heart squeezing when valves aren’t open, which sends blood backwards,” Robinson explains. 

Other symptoms that can occur with arrhythmias are lightheadedness or dizziness, sweating, shortness of breath, or chest pain. 

Arrhythmias are more common in older adults, but even children can get them. 

What to do if you’re having heart palpitations

First, look for any patterns in when your palpitations happen. If they seem to hit only when you’re doomscrolling, for example, that probably means they’re due to anxiety and something you could resolve by talking with a therapist or learning coping techniques. 

If your palpitations are harder to pin down but still not disrupting your life in any major way, Robinson recommends trying a heart-monitoring app, which you can download to your phone or smart watch. 

The apps are fairly sophisticated and mimic getting an electrocardiogram, or EKG, at your doctor’s office. They can also tell you if it’s possible you have an arrhythmia. 

However, if you’re more concerned about your palpitations, have other symptoms with them or have an underlying medical condition, it’s important to go to the doctor.

“The main goal of the patient-provider interaction is to find out if it’s an arrhythmia or not,” Robinson explains.

Some types of arrhythmia aren’t dangerous but may still need to be treated if they interfere with your life. Other types of arrhythmia — such as atrial fibrillation, the most common type in the United States — can put you at risk for heart failure or a stroke if left untreated. 

How to treat heart palpitations

If your app hasn’t noted any irregular heartbeats or your doctor tells you that you don’t have an arrhythmia — but you’re still getting palpitations sometimes — it’s probably time to revisit the causes of palpitations and try to figure out where yours are coming from.

Drinking multiple cups of coffee a day? It might be time to tone it down a bit. Having lots of anxiety? It could be helpful to consult with a mental health specialist about medication or starting therapy. 

For people who are diagnosed with an arrhythmia, treatment largely depends on how serious it is. 

If you have something like supraventricular tachycardia (SVT), which is a fast heartbeat that starts in the upper chambers of the heart, you may not need treatment unless the condition interferes with your life.

More serious arrhythmias, such as atrial fibrillation, can be treated with medication, catheter ablation or lifestyle changes to address underlying issues, such as changing your diet and exercise patterns to treat obesity. 

For Robinson, the most important point is that people seek answers, either from an app or from a doctor’s visit, instead of chalking their palpitations up to anxiety or something mild. 

She says she’s seen many patients first get diagnosed with an arrhythmia when they’ve just had a stroke — but an earlier diagnosis is usually possible to prevent anything that serious from happening.

“Don’t ignore palpitations if they’re catching your attention and interrupting your life. They may be due to a fixable problem and you don’t have to suffer from them,” Robinson says.

The info in this article is accurate as of the publishing date. While Right as Rain strives to keep our stories as current as possible, the COVID-19 pandemic continues to evolve. It’s possible some things have changed since publication. We encourage you to stay informed by checking out your local health department resources, like Public Health Seattle King County or Washington State Department of Health.