Heart Palpitations in Women: Is It ‘Just Anxiety,’ or Something More?

Marie-Noelle Langan, MD
Associate Professor
Medical Director of Operations, Electrophysiology
Division of Cardiology
Electrophysiology Section
Icahn School of Medicine at Mount Sinai

Heart Palpitations in Women: Is It ‘Just Anxiety,’ or Something More?

Do you ever feel like your heart has skipped a beat or is pounding, racing, or doing flip-flops? Most of the time these sensations, called heart palpitations, are harmless and merely bothersome, but sometimes they can signal a serious, possibly life-threatening arrhythmia (abnormal heart rhythm). Women — who are at higher risk than men for certain dangerous arrhythmias, and subsequent stroke in some cases — are often told that their palpitations are “just due to anxiety.” But even though they can be triggered by anxiety, it is important for doctors to rule out any dangerous arrhythmias before dismissing the palpitations as only the result of worrying.

Her Heart Palpitations

Unfortunately, heart palpitations are extremely common. They differ from one person to the next and can vary with a woman’s age and hormone levels.

  • Age: Palpitations caused by atrial fibrillation, a potentially dangerous, irregular heartbeat that compromises the heart’s ability to pump blood throughout the body, are more prevalent in both men and women over age 65.
  • Menstrual cycle: Palpitations that feel like skips or a running heartbeat often come with a woman’s menstrual cycle. Looping arrhythmia, a type of fast heart rhythm that results when a “short circuit” occurs in the electrical system of the heart, may also vary with the cycle.
  • Pregnancy: Pregnancy can elicit non-dangerous yet bothersome arrhythmias, but in some young women may also increase the incidence of dangerous but rare arrhythmias, such as those precipitated by Wolff-Parkinson-White syndrome. If you have had palpitations in the past and are planning to become pregnant, it’s important to address them beforehand, as they are more difficult to manage during pregnancy.
  • Menopause: Menopause is the most common time to have non-dangerous palpitations.

In addition, some medications, such as certain antibiotics and asthma drugs, can trigger heart palpitations. This can be particularly problematic for women who are predisposed to a type of rare but deadly heart rhythm disorder called long QT syndrome.

Recording Symptoms Is Key to Diagnosis

One of the problems with heart palpitations is that, like a squeaky car that neglects to make noise while in the repair shop, they are often intermittent and will not necessarily be present at the doctor’s office. If that is the case, it will help if you can describe in detail what the palpitations feel like. Your doctor should also refer you to a cardiologist, who can easily outfit you with a small device that will monitor and record your heart’s rhythm over several hours or days as you go about your daily activities. With today’s technology, there is no reason to refrain from recording symptoms of heart palpitations to help tease out whether they are due to a dangerous heart rhythm requiring treatment, or are merely annoying but safe.

If you are having prolonged heart palpitations, call your doctor’s office and tell them you are currently experiencing palpitations and want to come in right away for an electrocardiogram, or EKG, a test that checks for problems with the electrical activity of the heart. If you are still having the palpitations when you get to the doctor’s office, an EKG can definitively show whether or not the cause is atrial fibrillation, the most common dangerous, yet easily treatable arrhythmia.

If you have heart palpitations along with any of the following, see your doctor immediately to expedite diagnosis and treatment:

  • A family history of sudden cardiac death;
  • A personal history of heart disease;
  • Fainting.

Treating Heart Palpitations

The good news is that there is a variety of ways to address and treat heart palpitations, including those caused by the most dangerous arrhythmias.

  • Electrophysiology: Electrophysiology is a test that helps doctors find the cause of heart rhythm disturbances. As with an angiogram, the doctor threads a catheter, or thin flexible tube, to the heart through a vein in the groin, and then maps the heart’s electrical activity. Depending on the cause of the arrhythmia, the electrophysiology team may be able to fix it with a procedure right then and there.
  • Blood thinners: If the cause is atrial fibrillation, your doctor may prescribe blood thinner medication to help reduce the risk of blood clots and stroke.
  • Implantable defibrillator: An implantable cardioverter defibrillator (ICD) is a small device that can help protect patients at risk of some of the rarer life-threatening arrhythmias. Placed permanently in the chest, an ICD monitors the heart rhythm and shocks it back to normal in the event of a dangerous arrhythmia; it’s like having a mini 9-1-1 team inside your heart.

Many times, medically harmless palpitations will eventually go away on their own without treatment. Palpitations brought on by menopause, for instance, will often disappear when menopause is over. And palpitations precipitated by worry may go away once your doctor has confirmed through recording or testing that they are not the dangerous type. In addition, the following lifestyle changes can help you prevent or lessen the frequency of palpitations:

  • Abstain from caffeine and alcohol;
  • Stay well-hydrated;
  • Take a magnesium supplement (the recommended dietary allowance for adults ranges from 310 mg to 420 mg a day);
  • Reduce stress or anxiety.

If you have heart palpitations, odds are you have nothing to worry about. But don’t leave it to chance: if your doctor tells you, “Don’t worry, it’s nothing,” insist that he or she prove it by monitoring and recording your palpitations to rule out any dangerous arrhythmias.