When to go to the emergency department for heart palpitations

Most people barely notice their hearts beating. And that’s natural. But any noticeable change in the heartbeat should be concerning. Heart palpitations can be a sign of a serious condition, but some heart palpitations are totally normal.

I describe the feeling of heart palpitations as the heart-pounding sensation you get after running up a flight of stairs. But for people with heart palpitations, that feeling could just show up while they’re sitting on the couch.

What are heart palpitations?

A heart palpitation is the feeling of the heart racing or pounding. Heart palpitations may feel like the heart is:

  • Beating irregularly
  • Beating too quickly
  • Beating too strongly
  • Skipping beats

We see one or two patients per day who are complaining of these or similar symptoms. Patients sometimes tell me they can see their shirts move because their hearts are beating so hard.

Most heart palpitations aren’t dangerous. But they can be signs of several serious heart conditions. Get help if you feel heart palpitations that don’t go away quickly on their own. We’ll work to find what’s causing palpitations and refer you to additional care from a cardiologist if necessary.

"Get help if you feel heart #palpitations that don’t go away quickly on their own." via @MedStarWHC

What causes heart palpitations?

Older adults are more likely to have medical conditions that can increase their likelihood of having palpitations. But heart palpitations can show up in people of any age.

Some of the heart conditions that can cause heart palpitations include:

  • Cardiac arrhythmia (an irregular heartbeat), including atrial fibrillation (also known as A-fib) and atrial flutter
  • Supraventricular tachycardia (SVT)
  • Premature atrial complexes (PACs)
  • Premature ventricular complexes (PVCs)
  • Tachycardia

Other issues that can cause heart palpitations include: 

  • Being dehydrated
  • Caffeine, nicotine or alcohol
  • Certain medications, including decongestants or inhalers for asthma
  • Hormonal fluctuations in women who are menstruating, pregnant or about to enter menopause
  • Problems with electrolytes, including low potassium levels
  • Strong feelings of anxiety, fear or stress, including panic attacks

Overactive thyroid, also known as hyperthyroidism, can throw off the heart’s normal rhythm, causing palpitations. This type of thyroid disorder is treatable with medications to slow the heart rate and treat the overactive thyroid.

Heart palpitations and anxiety

Heart palpitations sometimes can be caused by extreme anxiety, rather than a heart condition. That might lead to a patient needing treatment for a possible anxiety disorder from a psychiatrist.

But we still have to make sure patients are checked out by a cardiologist for any possible heart problems first. We do have some patients who have been diagnosed before with anxiety and know that’s what’s happening. For the majority of patients, however, we don’t want to label their condition as an anxiety attack before knowing for sure that there isn’t a heart problem we need to address.

When to get help for heart palpitations

Most people’s hearts beat between 60 and 100 times per minute. If you’re sitting down and feeling calm, your heart shouldn’t beat more than about 100 times per minute. A heartbeat that’s faster than this, also called tachycardia, is a reason to come to the emergency department and get checked out. We often see patients whose hearts are beating 160 beats per minute or more. The body can’t sustain that for long periods of time.

You also should get checked out if you feel like your heart’s beating irregularly. The heart should beat steadily, like a metronome. If you feel like it’s pausing or skipping beats, that could be a sign of an abnormal heartbeat, which can increase the risk of a stroke.

"You should get checked out if you feel like your heart’s beating irregularly." via @MedStarWHC

If a patient comes into the emergency department while the palpitations are going on, we may be able to provide medications to slow the heart rate or convert an abnormal heart rhythm to a normal one. In extreme cases where medications aren’t enough, we may need to do a cardioversion. That’s when we shock the heart so it can reset itself to a normal rhythm. Patients are sedated during this procedure so they do not feel the electrical shock.  

Further testing for heart palpitations

In most cases, we see patients in the emergency department whose palpitations have either gone away or aren’t critical by the time they arrive. Like a car problem that clears up when you visit the mechanic, this can be frustrating for patients.  

We reassure them that just because we don’t see an abnormal heart rhythm now doesn’t mean that they didn’t have one before. We check for any signs of damage or injury, and we may monitor patients for a few hours at the emergency department to see if they have another episode of palpitions, but there may not be enough time to capture an abnormal heart rhythm that comes and goes.  

We often refer patients who have had heart palpitations to a cardiologist in the MedStar Heart & Vascular Institute. For example, we might diagnose an abnormal heart rhythm in the emergency department, but it’s not something that needs emergency treatment. Or we might not see evidence of an abnormal heart rhythm, but we think the patient could benefit from additional monitoring to rule out possible heart problems.  

A cardiologist can provide patients with special monitoring equipment to examine the heart’s rhythm. There are two main types of monitoring equipment. A Holter monitor will record the heart’s rhythm continuously for a defined time limit (often 24-48 hours), while an event recorder will only record briefly when a patient has symptoms of palpitations and presses a record button. If this testing shows evidence of a heart condition, our cardiologists work with patients to create an effective treatment plan.  

A normal heartbeat is easy to take for granted. So when we feel heart palpitations, it can be very scary. But with quick medical attention and advanced monitoring, your heart can beat steadily for a long time to come.

First in Northeast Region to Implant Investigational Stroke-Reducing Device

Washington, D.C., March 9, 2017 – MedStar Heart & Vascular Institute at MedStar Washington Hospital Center became the first facility in the Northeast region to implant an investigational device designed to prevent stroke in patients with atrial fibrillation (A-fib) or an abnormal heart rhythm.  

The electrophysiology team–Manish Shah, MD and Sarfraz Durrani, MD– implanted the AMPLATZER™ Amulet investigational device, as part of a nationwide clinical trial to evaluate the device’s safety and effectiveness. The Amulet works by sealing off the left atrial appendage (LAA), a small area of the heart, where blood clots form and migrate into the bloodstream, potentially causing a stroke.  

“The Amulet left atrial appendage closure system is a new device that may potentially offer protection to our patients at high risk of stroke who are poor candidates for blood thinning medications,” said Dr. Shah, who is the principal investigator of the Amulet trial and director of the Clinical Cardiac Electrophysiology Fellowship Training Program at MedStar Washington Hospital Center.  

In some patients with A-fib, the LAA does not contract effectively and it can become a source of blood clots. These clots can then be released into the heart and enter the bloodstream, where they can travel to the brain and cause a stroke. Currently, patients with A-fib are often prescribed blood-thinning medication, but this treatment option comes with a lifetime of medical management and the risk of major bleeding. By closing the LAA with the Amulet, physicians can block off the LAA and potentially reduce the risk of stroke.    

Patients enrolled in the clinical trial are randomly assigned to receive either the AMPLATZER™ Amulet or the WATCHMAN™, the only FDA-approved LAA closure device in the control arm of the study. The main difference between the two devices is that Amulet does not require patients to take blood thinners for 45 days after implantation.  

In the meantime, WATCHMAN has been a game-changer to protect A-fib patients from stroke. After WATCHMAN gained its FDA approval, MedStar Washington Hospital Center became the first facility in the Washington region to implant the device. To date, more than 100 patients have been outfitted with the WATCHMAN devices. That’s more implants than any other institution on the Mid-Atlantic seaboard. 

How the WATCHMAN™ Device Reduced Stroke Risk for A-fib Patient Connie Wiley

It’s been just over a year since the specialists at MedStar Washington Hospital Center implanted the WATCHMAN device in Connie Wiley, a grandmother of six from Woodbridge, Virginia, and she is feeling better than ever. Connie was one of the first patients in the world to receive this treatment, used to reduce the risk of stroke in patients with atrial fibrillation (A-fib), and since her procedure, we have performed more than 50 WATCHMAN procedures —the most in the Mid-Atlantic region.

If you're like Connie, you have had the shadow of atrial fibrillation and its associated complications looming over you. Atrial fibrillation (A-fib) is an arrhythmia of the upper two chambers of the heart. Because the blood flow from the atria to the ventricles in the heart is compromised due to an irregular heartbeat, blood pools (and consequently can clot) in the atria. In the past, the most common treatment for A-fib was a blood thinner, such as warfarin. However, the main problem with long-term blood thinner use is the risk of internal bleeding.

With atrial fibrillation, the risk of heart attack and stroke increases exponentially. Even blood thinners used to combat the clotting can have their own set of difficulties. However, the WATCHMAN gives hope to those who want complete freedom from some of the potential problems and complications of both A-fib and the medications used to treat it.

Connie's Story

As an avid gardener and grandmother of six, Connie hardly fits the image of a massive coronary and three-time stroke survivor. Looks, however, can be deceiving. A-fib was dragging Connie down, sapping her energy and leaving her feeling tired and unable to function at an optimal level.

“I am an active person, and I wanted to do things,” Connie reflected. “But my body wouldn’t let me do them.”

Not only was she feeling fatigued, her condition was also leading to strokes that could have eventually been fatal. But with a great team of cardiologists and other specialists on her side, Connie was able to reclaim her active lifestyle without the worry of another stroke on the horizon.

“If it wasn’t for them, I wouldn’t even be here,” she said.


The doctors at the MedStar Heart & Vascular Institute, located at MedStar Washington Hospital Center in Washington, D.C., gave Connie a new lease on life after her third stroke, caused by a blood clot that formed due to her atrial fibrillation. It was determined that Connie would be an excellent candidate for receiving an innovative device called the WATCHMAN. For the region, this procedure was the first of its kind. For Connie, she was one of the first WATCHMAN patients in the world.

Using minimally invasive techniques, surgeons introduced the WATCHMAN into her heart, closing off the left atrial appendage (LAA), the area in which most major clots in atrial fibrillation patients develop.

Life, Renewed

After she received the WATCHMAN, Connie almost instantly noticed an increase in her energy level -- she was able to start doing all of the things she'd thought she wouldn't ever be able to enjoy again. One of her biggest victories — and perhaps the moment she knew things were looking up — was when she was able to water her garden the evening of her return home following the implantation of her WATCHMAN device.

One Year Later

Just over a year after her procedure, Connie is feeling better than she has in a long time. Her energy continued to increase following her procedure, allowing her to resume all of her beloved activities. “Not only do I have energy now, I have peace of mind, knowing that I’m not going to stroke,” Connie shared.

At times, Connie's life can become complicated and stressful. Many of these instances would have spelled disaster before the WATCHMAN, precipitating the possibility of another stroke event. The WATCHMAN has allowed her to sail through each challenge without the worry of clots leaving the LAA and traveling to her brain again.

Another advantage Connie is quick to point out is that she has also been able to discontinue her blood thinners, making the possibility of a bleeding event almost nonexistent. Although they can be the difference between life and death for many patients, blood thinners can heighten the risk of bleed-out from even the slightest bumps and bruises — many of which Connie experiences chasing after her six wonderful grandchildren.

If you suffer from atrial fibrillation and are at an increased risk for stroke, you may want to consider the option of the WATCHMAN. By taking control of your A-fib and its associated risks, you, just like Connie, can take your life back and live it on your terms.

Have questions?

We are here to help! If you have any questions about MedStar Washington Hospital Center, call us at 202-877-3627.

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