The heart may be one of the hardest working muscles in the body, but we rarely notice it doing its job day in and day out. Until, that is, something out of the ordinary happens—like a sudden flutter, a skipped beat, or a racing pulse. Most of the time, heart palpitations are fleeting and not signs of something serious, but they're worth paying attention to nonetheless. Here are a few things that can cause your heart to switch up its rhythm, and how you should know when to see a doctor.
Drinking large amounts of alcohol at a time can cause heart palpitations sometimes known as “holiday heart syndrome.” But for people who drink frequently, even small amounts of alcohol can raise their risk of an irregular heartbeat, according to a 2016 study in the Journal of the American College of Cardiology.
“Alcohol usually lowers blood pressure, so the heart has to work harder to pick up the slack,” says Regina Druz, M.D., associate professor of cardiology at Hofstra University and Chief of Cardiology at St. John Episcopal Hospital in New York City. Experts also say that alcohol may affect the autonomic nervous system or damage the cellular signals that help keep heart rate consistent.
Energy drinks that contain high levels of caffeine have been associated with abnormal heart rhythms and increased blood pressure. And caffeine stimulants in pill or concentrated “shot” forms can have the same effects, says Laxmi Mehta, M.D., director of the Woman’s Cardiovascular Health Program at the Ohio State University Wexner Medical Center.
Even large amounts of coffee and tea can trigger fast or irregular heart beats in people who are sensitive to caffeine, says Druz. “I’ve had patients who’ve started drinking lots and lots of green tea, not realizing how much caffeine it has, and they come back with cardiac arrhythmias and can’t figure out why.”
It’s common for stress to affect heart rate, says Mehta, even for people who aren’t prone to full-out panic attacks or anxiety spells. Feeling your heart flutter when you’re nervous is a sign of your body’s fight-or-flight mechanism kicking in, she says; you may be able to bring it back to normal with deep breathing or relaxation exercises.
A very sudden stressful or surprising event, like the death of a loved one, can also trigger something known as broken-heart syndrome. This condition can feel like a heart attack, but symptoms usually resolve within a few weeks with no lasting damage.
“Very often people who suffer from acid reflux develop palpitations, because of the location of the esophagus—it can actually irritate the covering of the heart,” says Druz. If palpitations are happening after a meal or when you lie down at night, or they’re accompanied by heartburn, these are clues that reflux may be to blame.
Not staying properly hydrated can cause low blood pressure and electrolyte imbalances, which can force the heart to work harder and sometimes feel like it’s skipped a beat, says Mehta. “Luckily, there’s usually a simple fix,” she says. “Just drink more water.”
Drugs and supplements
“People who are taking stimulants for weight loss, or stimulant medications for ADHD or depression, may certainly notice heart palpitations as a side effect,” says Mehta. Some smokers may even notice that nicotine, also a stimulant, has an affect on their heart rate.
Other types of medications have been linked with a more serious form of heart irregularity. A 2011 study published in BMJ found that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs)—a common type of painkiller that includes ibuprofen and aspirin—may raise the risk of atrial fibrillation, which has been linked to blood clots and stroke.
A large meal
Anything that stretches the stomach—like a large, fatty meal—can trigger temporary heart symptoms, says Druz. “Your body has to rush blood to the stomach and spend energy digesting it,” she says, “and it’s not unusual for people to feel their heart rate is a little faster or feel like it skips a beat.”
In any of these circumstances, an occasional heart flutter is probably nothing to worry about, says Druz. But if you notice heart palpitations becoming more frequent—or they’re accompanied by other symptoms like chest pain or dizziness—talk to your doctor about whether they may be signs of something more serious.