A Fluttering Heart

Q: One night I awoke with a fluttering heart. I went to the ER and was told they were just heart palpitations. My heart has calmed down somewhat but the fluttering is still there, on the left side. I’ve had a battery of tests, but they all came back perfect. What causes these palpitations? I am 55, exercise about every day, don’t drink or smoke, don’t drink caffeine, and eat healthily. My cholesterol was 132 at the last check.

A: It sounds as though your physician has ruled out cardiac concerns (mitral valve prolapse, coronary artery disease, heart rhythm problems, others) through a “battery of tests” as a cause for your palpitations. Additionally, you incorporate a healthy lifestyle with good nutrition and exercise. This is very good news and does lend to a sense of relief.  However, it is important to know that your heart fluttering may also be triggered by non-cardiac factors such as lifting weights, being anxious or even from lack of sleep.

Palpitations are often described as sensations of a rapidly or irregularly beating heart. Some describe the experience as “skipping a beat” or a “jumping around your chest” kind of feeling. While many have these sensations from time to time with little more than an occasional feeling of a “racing heart,” others get significant symptoms such as shortness of breath, chest pain or even a feeling they are about to pass out.

Finding the cause for palpitations requires some detective work. Information your physician will want to know includes:

• When did they begin (weeks, months or years ago)?
• How long do they last (minutes, hours or days)?
• What time of day (morning, afternoon, evening)?
• Are other symptoms present (chest pain, shortness of breath, dizziness, lightheadedness, others)?
• Are you taking any prescription over-the-counter medications, dietary supplements or substances of abuse?
• Do these symptoms run in your family?

It’s good to hear that you avoid three of the more common non-cardiac triggers for palpitations—caffeine,  tobacco and alcohol—but there are additional concerns that may cause your symptoms. These include but aren’t limited to:

• Anemia
• Thyroid disorder
• Hypoglycemia (low blood sugar)
• Low magnesium or potassium
• Infection or fever
• Premenstrual syndrome or hormone changes associated with menstruation, pregnancy or menopause
• Fatigue or lack of sleep
• Stress or anxiety
• Obstructive sleep apnea
• Medications including decongestants, certain antidepressants, and stimulants found in some energy and weight loss products.

That being said, I want to mention the tests physicians may order when ruling out a cardiac reason for palpitations.  Please know this work-up is tailored to the individual person and is based upon their symptoms, age, cardiac history and other medical problems (diabetes, high blood pressure, others). These include:

• EKG
• Blood tests (for anemia, thyroid disorders, others)
• Echocardiogram (ultrasound picture of your heart and its’ valves)
• Holter monitor (checks for irregular heartbeats and heart rate over one or several days)
• Exercise stress test.

If the work-up suggests a cardiac concern, further tests would be ordered. These include an electrophysiologic study (EPS) (check the electrical system of your heart), tilt table test (if you had fainting spells along with your palpitations) and potentially, a cardiac catheterization.

While palpitations can be worrisome and disturbing, they are often no more than a temporary and harmless sensation. However, it is also important to know that palpitations may occasionally signal a more serious medical condition, one that deserves a full and thorough medical evaluation. When (and if) reasons for the palpitations are found, treatment is targeted toward reducing the risks, treating the symptoms or correcting the cause.

More From Dr. Rob:

• Unusual Food Allergies
• Silencing a Snoring Spouse
• Listening to the Female Heart
• When Menopause Dampens Desire

Find all articles by Dr. Rob.

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)