About Palpitations and Shortness of Breath
Palpitations (a racing heart, or a feeling of skipped beats) and shortness of breath (difficulty breathing, panting) can be signs from various body systems, including the heart, lungs, thyroid, and autonomic nervous system. The causes range widely, from temporary issues due to simple fatigue or anxiety, to urgent cardiac conditions like arrhythmia, heart failure, and myocardial infarction.
At our clinic, we perform electrocardiograms (ECGs), chest X-rays, and blood tests on the same day to comprehensively evaluate the cause. If an arrhythmia or cardiac disease is suspected, we promptly coordinate with specialized cardiovascular institutions.
Signs that require immediate medical attention
Palpitations and shortness of breath accompanied by the following symptoms are highly urgent, so consider calling for emergency assistance (119): severe chest pain, fainting, loss of consciousness, cold sweats, extreme difficulty breathing, hemiplegia, or slurred speech.
Main Causes of Palpitations
Cardiac Origin (Cardiogenic)
| Condition | Characteristics |
|---|---|
| Premature beats (Supraventricular/Ventricular) | Skipped beats, most common, often just observed |
| Atrial Fibrillation (AF) | Sudden irregular rapid palpitations, stroke risk |
| Paroxysmal Supraventricular Tachycardia (PSVT) | Regular rapid palpitations that start and end suddenly |
| Ventricular Tachycardia (VT) | May be accompanied by syncope, urgent |
| Sinus Tachycardia | Physiological tachycardia due to exercise, fever, anxiety |
| AV block | Bradycardia, dizziness, syncope |
| Ischemic heart disease (Angina/Myocardial infarction) | Palpitations + chest pain, cold sweats, shortness of breath |
| Heart failure | Exertional shortness of breath, lower limb edema, nocturnal dyspnea |
| Valvular heart disease | Heart murmur present, causes shortness of breath/palpitations as it progresses |
| Cardiomyopathy | Palpitations, shortness of breath, syncope |
Non-cardiac Causes
| Condition | Characteristics |
|---|---|
| Hyperthyroidism (Basedow's disease) | Tachycardia, weight loss, sweating, hand tremors |
| Anemia | Exertional palpitations, shortness of breath, fatigue |
| Fever/Infection | Reflex tachycardia |
| Panic disorder/Anxiety disorder | Paroxysmal palpitations, breathlessness, fear |
| Hyperventilation syndrome | Accompanied by numbness/tingling in limbs, dizziness |
| Autonomic nervous system dysfunction | Varies with physical condition |
| Hypoglycemia | When hungry, sweating, trembling |
| Excessive caffeine/alcohol | Lifestyle-related |
| Drug-induced | Bronchodilators, thyroid medications, cold medicines, etc. |
| Dehydration | Reflex tachycardia |
| Menopausal symptoms | Palpitations due to hormonal fluctuations |
Main Causes of Shortness of Breath
Respiratory Origin
| Condition | Characteristics |
|---|---|
| Bronchial asthma | Wheezing, paroxysmal dyspnea, worsening at night |
| COPD (Chronic Obstructive Pulmonary Disease) | History of smoking, exertional dyspnea, chronic cough and sputum |
| Pneumonia | Fever, cough, chest pain, dyspnea |
| Pulmonary embolism | Sudden dyspnea, chest pain, urgent |
| Pneumothorax | Sudden chest pain + dyspnea |
| Interstitial pneumonia | Exertional dry cough, progressive shortness of breath |
| Lung cancer | Persistent cough, hemoptysis, weight loss |
Cardiac Origin
- Heart failure (exertional/nocturnal dyspnea, orthopnea)
- Ischemic heart disease
- Valvular heart disease
- Cardiomyopathy
- Arrhythmia (tachyarrhythmia, bradyarrhythmia)
Other
- Anemia
- Obesity/Lack of exercise
- Anxiety/Panic attack
- Late pregnancy
- Reduced oxygen carrying capacity (e.g., CO poisoning)
Narrowing Down Causes by Palpitation Characteristics
| Palpitation Characteristics | Suspected Condition |
|---|---|
| Skipped beats (missing beats) | Premature beats |
| Regular tachycardia that starts and ends suddenly | Paroxysmal Supraventricular Tachycardia (PSVT) |
| Irregular and fast palpitations | Atrial Fibrillation |
| Slow pulse/dizziness | Bradyarrhythmia/AV block |
| Strong palpitations even at rest | Hyperthyroidism, anemia, anxiety disorder |
| Palpitations only during exercise | Physiological, anemia, heart failure |
| Palpitations + hand tremors, weight loss, sweating | Hyperthyroidism |
| Palpitations + dizziness, syncope | Severe arrhythmia, orthostatic hypotension |
| Palpitations + shortness of breath, lower limb edema | Heart failure |
| Palpitations + strong anxiety, fear | Panic disorder |
About Atrial Fibrillation
A particularly noteworthy condition among palpitations
Atrial fibrillation is common in the elderly and increases the risk of stroke by approximately 5 times. Many individuals are asymptomatic, so detection during health check-ups or prompted by palpitations is crucial. Early treatment (anticoagulation, rate control, rhythm control) can prevent stroke and heart failure.
Characteristics of Atrial Fibrillation
- Irregular rapid pulse (approximately 100-160 beats/minute)
- Palpitations, shortness of breath, fatigue, dizziness
- May be asymptomatic (often leading to delayed discovery)
- Induced by aging, high blood pressure, heart disease, alcohol consumption, thyroid disease
- Three patterns: paroxysmal, persistent, chronic
Three Pillars of Treatment
- Anticoagulation therapy: DOACs (e.g., Eliquis, Lixiana) to prevent stroke
- Heart rate control: Beta-blockers, calcium channel blockers
- Rhythm control: Antiarrhythmic drugs, catheter ablation
Warning Signs Requiring Immediate Medical Attention
- Palpitations accompanied by severe chest pain (possible myocardial infarction or dissection)
- Palpitations accompanied by syncope (severe arrhythmia)
- Severe difficulty breathing
- Pale face, cold sweats, lightheadedness
- Clouded consciousness
- Hemiplegia, slurred speech (suspected concurrent stroke)
- Sudden unilateral leg swelling + shortness of breath (suspected pulmonary embolism)
- First occurrence of strong palpitations lasting a long time
- Pulse during palpitations is remarkably fast/slow/irregular
Consultation and Examinations at Our Clinic
Key Points of Medical Interview
- Nature of palpitations (skipped beats, continuous, sudden onset)
- Time of onset, duration, frequency
- Triggering factors (exercise, rest, food, stress)
- Accompanying symptoms (chest pain, shortness of breath, dizziness, syncope)
- Lifestyle habits (caffeine, alcohol, smoking)
- Past medical history, family history (sudden death, heart disease)
- Medications being taken (thyroid medication, bronchodilators, etc.)
Examinations Available on the Same Day
| Examination | Purpose |
|---|---|
| 12-lead Electrocardiogram (ECG) | Diagnosis of arrhythmia, ischemia, premature beats |
| Chest X-ray | Cardiomegaly, pulmonary congestion, lung disease |
| Blood pressure, oxygen saturation | Circulatory and respiratory status |
| Blood test (TSH, FT4) | Thyroid function (Basedow's disease, etc.) |
| CBC, ferritin | Evaluation of anemia |
| Electrolytes, BNP | Heart failure markers |
| Blood sugar, HbA1c | Hypoglycemia, diabetes |
| SpO₂, breath sounds | Evaluation of respiratory diseases |
Examinations Requiring Referral
- Holter ECG (24-hour ECG): Detection of paroxysmal arrhythmias
- Echocardiography (cardiac echo): Evaluation of cardiac function, valvular disease, cardiac hypertrophy
- Exercise stress ECG: Evaluation of exertional ischemia
- Coronary CT: Detailed examination for angina
- Cardiac MRI: Detailed examination for cardiomyopathy
- Electrophysiology study/Catheter ablation: Curative treatment for tachyarrhythmias
- Chest CT/Pulmonary function test (spirometry)
Treatment Options
Premature Beats (often observed)
- If symptoms are mild, observation and lifestyle guidance
- If symptoms are severe, beta-blockers
- If underlying heart disease exists, specialized treatment
Atrial Fibrillation
- Anticoagulation therapy: Evaluated by CHADS2 score, many receive DOACs
- Rate-control drugs: Bisoprolol, verapamil
- Rhythm-control drugs: Flecainide, pilsicainide
- Catheter ablation: Curative treatment (referral to specialist facility)
Tachyarrhythmias (PSVT, VT)
- During an attack: Valsalva maneuver (bearing down), cold stimulation
- Medication (verapamil, beta-blockers, etc.)
- Ablation for cure
Non-cardiac Causes
| Cause | Treatment |
|---|---|
| Hyperthyroidism | Antithyroid drugs (Methimazole, Propylthiouracil) |
| Anemia | Iron supplements, investigation of cause |
| Panic disorder | SSRI, as-needed anxiolytics, cognitive behavioral therapy |
| Hyperventilation syndrome | Breathing technique guidance, as-needed anxiolytics |
| Autonomic nervous system dysfunction | Lifestyle rhythm, herbal medicine, beta-blockers |
| Drug-induced | Review of causative drugs |
Herbal Medicine (Kampo)
- Saikokaryukotsuboreito (Chai Hu Jia Long Gu Mu Li Tang): Palpitations with irritability/insomnia
- Shakkyakukanzoto (Zhi Gan Cao Tang): Irregular pulse/palpitations
- Ryokeijutsukanto (Ling Gui Zhu Gan Tang): Dizziness/palpitations
- Kamishoyosan (Jia Wei Xiao Yao San): Menopausal palpitations
- Hangekobokuto (Ban Xia Hou Po Tang): Sensation of lump in throat and palpitations
Self-Care and Lifestyle Improvement
Habits to Avoid
- Excessive caffeine intake (coffee, energy drinks)
- Excessive alcohol consumption/binge drinking
- Smoking
- Sleep deprivation/Irregular lifestyle
- Overwork/Excessive stress
- Extreme dieting (dehydration, hypoglycemia, hypokalemia)
Habits to Incorporate
- Regular sleep (around 7 hours)
- Moderate aerobic exercise (walking, swimming)
- Balanced diet, iron, vitamins
- Hydration (dehydration prevention)
- Deep breathing/Relaxation
- Self-monitoring of blood pressure/pulse (for detecting atrial fibrillation)
- Smoking cessation/Moderate alcohol consumption
Dealing with Panic Attacks
Regain composure with breathing techniques
Breathe in for 4 seconds → Hold for 4 seconds → Exhale for 6-8 seconds. Tell yourself, "This attack won't kill me," and "It will pass." Paper bag breathing is no longer recommended due to the risk of hypoxia.
Frequently Asked Questions
I feel like my heart is skipping beats, is this a medical condition?
Mostly, it's premature beats, which are common even in healthy individuals. They are often incidentally found on routine ECGs, and in most cases, observation is sufficient. However, if accompanied by syncope, chest pain, long duration, or more than 10 times per minute, please consult a doctor.
If I get an ECG during palpitations, will the cause be found?
If an ECG can be taken during an attack, diagnosis is easy, but paroxysmal arrhythmias often resolve by the time of examination. Therefore, a Holter ECG (24-hour ECG) for long-term recording is effective, and if necessary, we will refer you to a specialized cardiovascular institution.
Are palpitations from coffee a medical condition?
Individuals with high caffeine sensitivity may experience palpitations even after 1-2 cups of coffee. This is often a normal physiological response and not a concern, but if strong palpitations persist after a small amount of coffee, it could indicate conditions like hyperthyroidism, so a check-up is recommended.
What happens if atrial fibrillation is left untreated?
Atrial fibrillation increases the risk of stroke by about 5 times. Also, prolonged atrial fibrillation increases the risk of heart failure. Appropriate anticoagulation and rate/rhythm control can significantly reduce these risks.
Can thyroid problems cause palpitations?
Yes. It is a classic symptom of Basedow's disease (hyperthyroidism). In addition to palpitations, it can be accompanied by weight loss, sweating, hand tremors, and bulging eyes. It can be diagnosed with blood tests (TSH, FT3, FT4).
Should exertional shortness of breath be ignored?
Shortness of breath appropriate for one's age and fitness level is physiological, but if there are changes such as shortness of breath during activities previously manageable, progressive exertional dyspnea, or delayed recovery after exertion, there may be a possibility of heart failure, anemia, or respiratory disease, and consultation is recommended.
I was told my tests were normal, but I still have palpitations.
Even without structural heart disease, palpitations can be caused by premature beats, autonomic nervous system dysfunction, panic disorder, or hyperventilation syndrome. Treatment tailored to the symptoms can bring improvement. You can also consult our clinic for psychotherapeutic approaches.
How do I check my own pulse?
Place your fingers on the radial artery on the thumb side of your wrist or the carotid artery in your neck, count for 15 seconds and multiply by 4 (or count for 60 seconds). A normal pulse is 60-100 beats per minute and regular. In atrial fibrillation, it is fast and irregular. Smartwatch ECG functions can also be utilized.
Features of Palpitation and Shortness of Breath Care at Our Clinic
- 12-lead ECG, chest X-ray, and blood tests available on the same day
- Evaluation of systemic diseases including thyroid function, anemia, electrolytes, and BNP
- Prescription of beta-blockers, antiarrhythmic drugs, and anticoagulants
- Referral for Holter ECG, echocardiography, and coronary CT to specialized cardiovascular institutions
- Management of anticoagulation therapy (DOACs) for atrial fibrillation
- Psychotherapeutic approaches for panic disorder and hyperventilation syndrome
- Combination with herbal medicines (Saikokaryukotsuboreito, Shakkyakukanzoto, etc.)
- Lifestyle guidance (caffeine, alcohol, exercise)
- Walk-ins/same-day appointments OK / Open daily from 9 AM to 9 PM / 1-minute walk from Jujo Station
Do not "wait and see" – get evaluated
Palpitations and shortness of breath can be the first sign of heart disease. Atrial fibrillation, in particular, can progress asymptomatically and cause strokes. If you are concerned, please get an ECG and blood test for evaluation. Early detection and treatment can prevent serious complications.
