How to tell if heart palpitations are due to stress, or caused by something more sinister.

We spoke to Consultant Cardiologist Dr Reginald Liew from the Harley Street Heart and Vascular Centre to learn more about heart palpitations and when you should see a doctor.

What are heart palpitations and have they become more common during the pandemic?

If you felt your heart pound or skip a beat after vigorous exercise or hearing bad news, chances are you have had heart palpitations. Fortunately, heartbeats that feel irregular are usually normal, experienced by most people, and are usually nothing to worry about.

However, some palpitations could be a sign of potentially deadly arrhythmia that may result in stroke, heart failure, blackouts, and even cardiac arrest.

Dr Liew has seen an uptick of heart palpitations and ectopic heartbeats during the Covid-19 pandemic and attributes this to stress from having to adjust working and living conditions to reduce transmission of the virus.

Heart palpitations are when the heartbeat becomes more noticeable. Normally caused by strong emotions such as anxiety, and mechanisms for coping with stress such as smoking, and caffeine, drug and/or alcohol use, heart palpitations can feel like your heart is skipping, fluttering rapidly, pounding too fast, or flip-flopping.

On the other hand, an ectopic heartbeat is characterised by a missed or extra heartbeat when something goes awry in your heart’s electrical system, such as when the electrical signals that control your heartbeat cause the heart’s ventricles to contract a little too soon. Ectopic beats can feel similar to palpitations – fluttering, pounding, skipping – and can also be triggered by stress, anxiety, lack of sleep, alcohol and/or drug use, increased caffeine intake, and high blood pressure.

Exposure to the Covid-19 virus could also cause arrhythmia, particularly atrial fibrillation, according to studies. Dr Liew explains, “While several studies have shown a link between Covid-19 and irregular heartbeats, the association between palpitations and psychological distress has long been established. And, thanks to the pandemic, an increasing number of patients have sought treatment for palpitations due to severe stress and anxiety amid fears of infection, financial losses, and longer working hours from working remotely.”

Consultant Cardiologist Dr Reginald Liew from the Harley Street Heart and Vascular Centre

How do stress and anxiety cause heart palpitations or ectopic heartbeats?

Stress and anxiety impact your heart by activating the fight-or-flight mechanism. This response releases adrenaline, and the stress hormone, cortisol, to elevate your blood pressure and breathing to help you deal with difficult situations more effectively.

“When our ancestors were hunter-gatherers, this response was vital as it primed them to have more energy and alertness to fight rivals and run from predators. Once these threats passed, cortisol and adrenaline levels returned to normal, as did breathing and heart rates,” Dr Liew remarked.

“In today’s world however, perceived threats persist. Whether it’s Covid-19, rushing a deadline or having meetings round the clock, stress is constant, keeping heart rates high for days, weeks, even months. Unfortunately, when the stress response is constantly activated, it can lead to high blood pressure, heart palpitations and ectopic heartbeats, which can increase your risk of deadly heart complications.”

Are heart palpitations/ ectopic beats dangerous?

Although most heart palpitations and ectopic heartbeats are not dangerous, Dr Liew warns that palpitations can be a sign of atrial fibrillation, a type of life-threatening arrhythmia which increases your risk of stroke and heart failure. Ectopic heartbeats, on the other hand, increases one’s risk of ventricular tachycardia, another type of deadly arrhythmia which may cause blackouts or cardiac arrest.

So, how can we tell if our irregular heartbeats are dangerous?

According to Dr Liew, infrequent palpitations or those that last only a few seconds do not usually need to be evaluated. Conversely, if you have a history of heart conditions and are experiencing palpitations which are getting worse, talk to your cardiologist, who may prescribe an electrocardiogram (ECG) test, which is a painless, non-invasive way of recording the electrical signals in your heart, or remote ECG monitoring using a Holter monitor. Holter monitors can record continuous ECG for up to 48 hours to help identify potential arrhythmia.

“Contact your doctor if the pounding is accompanied by chest pain, fainting or light-headedness, or if your symptoms get worse, even with medication,” he says.

How are palpitations and ectopic heartbeats treated?

Depending on the underlying cause, ectopic heartbeats can be treated with beta-blockers. In severe cases, catheter ablation may be recommended to control the heart’s electrical signalling so it beats normally again. Fortunately, since most ectopic heartbeats and palpitations do not require medical treatment, they can be controlled at home with lifestyle changes. Dr Liew recommends the following:

Breathing and relaxing: Palpitations and ectopic heartbeats often occur in times of stress. When your heart starts to pound, take deep breaths as this calms the body and slows down the heart rate.

Addressing anxiety: Anxiety and panic attacks can cause palpitations and ectopic heartbeats. Panic attacks are often debilitating and can occur out of the blue with no clear trigger.  If your panic attacks or anxiety interfere with your day to day life, talk to a mental health professional.

Staying away from stimulants: Palpitations and ectopic heartbeats can be set off by stimulants such as caffeine, nicotine, and certain drugs. Limiting or avoiding these can prevent potential episodes.

Drinking responsibly: Alcohol increases your risk of palpitations and atrial fibrillation. Try limiting your intake to no more than one standard drink a day for women, and two standard drinks a day for men.

Exercising regularly, but safely: Regular exercise controls arrhythmia and can prevent ectopic heartbeats. However, while getting physical is great for your heart, strenuous activity can cause serious palpitations. If you find yourself gasping for air or clutching your chest while working out, dial down the intensity or avoid that exercise altogether. You might also want to visit a cardiologist who can run some tests and recommend types and levels of exercise that are safer for you to practise.

Eating healthily: The Mediterranean diet which is rich vegetables, fruits, whole grains, olive oil has been shown in clinical trials to prevent heart disease and reduce risk of atrial fibrillation.

Featured photo by Dreamstime.
Dr Reginald Liew’s photo courtesy of The Harley Street Heart and Vascular Centre