How to Stop Heart Palpitations: Evidence, Recommendations, and Comprehensive Strategies

If you’re wondering how to stop heart palpitations, you’re not alone. These sensations, while often benign, can be disconcerting, especially if they occur frequently or without apparent reason.

In previous entries of this series, I explored the nuances of heart palpitations.

Heart Palpitations and Anxiety: What to Do When You Wake Up with a Racing Heart
When to Worry About Heart Palpitations and Ectopic Beats
What are Heart Palpitations: Understanding Their Connection with Anxiety, Perimenopause, and Menopause

Now, let’s shift our focus from understanding to action. This post delves into the effective strategies and the latest science on how to stop heart palpitations, particularly those influenced by anxiety or hormonal changes.

Understanding Research Limitations

When you look into effective ways to manage heart palpitations, it’s essential to recognize the current limitations in research. In my examination of a comprehensive review by Sheng et al. (2021), focused on menopausal symptom treatments, I discovered a notable gap in high-quality studies that specifically target heart palpitations. Out of 670 articles reviewed, only 37 met the criteria for inclusion, and these studies often lacked the rigorous design necessary to provide conclusive results. Most offered only Level II/III evidence, hindered by small sample sizes and inconsistent methodologies.

This significant shortage underscores the critical need for well-designed, randomized controlled trials. These limitations have led to a situation where no current therapy can be recommended as a definitive solution for managing heart palpitations universally in clinical practice. Among the treatments analyzed, hormonal therapies, particularly estradiol, showed some potential in alleviating the frequency and severity of palpitations. The authors conclude that support for these treatments isn’t strong enough for a broad recommendation.

However, it’s important to underscore that this landscape is likely to change. As more high-quality research emerges, exploring new and evolving treatments, our understanding and management of heart palpitations, particularly those linked to hormonal changes, will undoubtedly improve. This evolving knowledge will pave the way for more definitive and tailored treatment recommendations in the future. For now, I advise a cautious and well-informed approach when considering treatment options, always in consultation with healthcare professionals.

Hormonal Treatments

When it comes to managing heart palpitations during menopause, hormonal therapies like estradiol have shown some potential. This is especially relevant as we sift through the findings from the systematic review by Sheng et al. (2021), which offers a comprehensive look at various treatment modalities. However, while hormonal treatments may present a ray of hope, they come with their own set of complexities and limitations.

Efficacy of Hormonal Therapies: The review included 15 studies that focused on hormonal agents such as estrogen, progesterone, tibolone, and raloxifene. These studies varied widely in terms of design and outcomes, often utilizing self-report tools like the Kupperman Index and the Menopause Rating Scale for assessing palpitations. The results were decidedly mixed:

• Some studies reported that hormonal therapies improved palpitations compared to baseline. However, these benefits were not consistently observed when compared to placebo treatments.
• In certain cases, hormonal treatments performed on par with or slightly better than non-hormonal alternatives like isoflavones. Interestingly, combining hormonal therapies with psychological interventions seemed to enhance outcomes, suggesting a synergistic effect.
• Yet, it’s crucial to note that not all studies found benefits; in fact, some reported no change or even worsening of palpitations among participants.

These mixed results underscore the importance of proceeding with caution. The variability in study designs and the small sample sizes limit the strength of the conclusions we can draw from this data.

Non-Hormonal Medical Treatments

Exploring non-hormonal options for managing heart palpitations brings us into a territory where evidence remains sparse and often inconclusive. The review by Sheng et al. (2021) sheds light on the effectiveness of non-hormonal drug therapies, such as SSRIs/SNRIs and antihypertensives, in treating menopausal heart palpitations. Here’s a closer look at what the findings tell us:

SSRI/SNRI Treatments:

• In the studies examined, SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) were explored in the context of menopausal symptoms. Interestingly, palpitations were often reported not as a symptom being treated but as an adverse effect of these medications. This paradoxical outcome highlights the complexity of using these drugs in the context of menopause.
• The evidence from these three studies was not only scant but also inconclusive, providing no solid foundation to recommend SSRIs or SNRIs for the relief of heart palpitations. Given the lack of targeted research and clear outcomes, it’s challenging to position these commonly prescribed antidepressants as viable options for this specific symptom.

Antihypertensive Treatments:

• The review included a look into antihypertensives, specifically moxonidine and atenolol. Some studies suggested that these medications could reduce the frequency of palpitations. However, the lack of a placebo group in these studies significantly weakens the reliability of such findings. Without robust control measures, it’s difficult to ascertain whether the observed effects were due to the medication or other unrelated factors.
• Consequently, the current evidence does not support a broad recommendation for using antihypertensive medications to manage heart palpitations in menopausal women. The findings indicate a need for more rigorously designed trials that can provide clearer answers.

Emerging Non-Hormonal Treatments: The Case of Fezolinetant

In the evolving landscape of treatments for menopausal symptoms, there’s promising news with the recent FDA approval of a new drug called fezolinetant. This drug is specifically designed to treat hot flashes and other vasomotor symptoms associated with menopause. Given the frequent co-occurrence of hot flashes and heart palpitations among menopausal women, fezolinetant presents a potential avenue for also alleviating palpitations.

Fezolinetant and Heart Palpitations:

• Connection to Hot Flashes: Hot flashes are one of the most common and disruptive symptoms of menopause, often accompanied by heart palpitations. These symptoms are thought to be linked through shared physiological pathways, particularly involving the body’s temperature regulation and cardiovascular system.
• Potential for Symptom Relief: While fezolinetant targets the mechanisms underlying hot flashes, its effect on heart palpitations could be indirect. By mitigating one trigger (hot flashes), there’s potential to reduce the incidence or severity of palpitations. However, it’s important to note that this is a speculative benefit at this stage.

Currently, the literature specifically addressing the impact of fezolinetant on heart palpitations is still in its infancy. The primary focus of research and clinical trials has been on its efficacy in treating vasomotor symptoms, without direct assessment of its effects on heart palpitations. To understand whether fezolinetant could be a viable option for treating heart palpitations in menopausal women, dedicated studies are necessary. These studies would need to explicitly measure changes in palpitation frequency and severity among participants using fezolinetant, ideally with rigorous methodology and control conditions.

Exploring Non-Drug Therapy Options for Heart Palpitations

When considering treatments for heart palpitations, especially during menopause, many of you might look beyond traditional medications to non-drug therapies. In the systematic review by Sheng et al. (2021), various supplementary treatments like isoflavones, phytoestrogens, and several herbal remedies were analyzed to assess their efficacy in managing heart palpitations. Here’s what the review found:

Isoflavones and Phytoestrogens:

• Mixed Results: The studies included in the review present mixed outcomes on the effectiveness of isoflavones and other phytoestrogens in alleviating menopausal heart palpitations. Some research suggested potential benefits, while others showed no significant difference compared to placebo. This inconsistency highlights the challenges in conclusively recommending isoflavones for palpitations.
• Current Evidence: Due to the generally low quality of the available studies and their inconsistent results, the evidence does not strongly support the use of these supplements specifically for managing palpitations. Clearly, more rigorous and well-designed studies are needed to solidify their role in treatment.

Rheum Rhaponticum (Siberian Rhubarb):

• Potential Benefits: Siberian rhubarb, particularly its extract ERr 731, shows some promise in potentially reducing menopausal symptoms that include palpitations. Although some individual studies report significant reductions in symptoms, the overall evidence remains too sparse to provide a solid endorsement.
• Safety and Efficacy: Initial research suggests that Siberian rhubarb might be safe and effective due to its selective action on specific estrogen receptors. However, conclusive results from comprehensive, well-conducted clinical trials are essential to fully endorse its use.
• Broader Health Benefits: Preliminary data suggest potential antioxidant and anti-inflammatory benefits of Siberian rhubarb, which adds to its appeal. Yet, these effects require confirmation through more rigorous scientific research to be considered reliable.

Salvia Officinalis (Sage):

• Inconclusive Evidence: The review notes that while one controlled trial indicated sage might reduce palpitations, subsequent studies did not consistently support these findings. Consequently, the evidence to recommend sage as an effective treatment for palpitations is currently insufficient and highlights the need for further research.

The review also covered treatments like Tribulus terrestris and ayurvedic remedies. Although some reductions in palpitations were reported, the evidence remains too limited and inconsistent. This variability stresses the urgent need for more robust research to evaluate these treatments comprehensively. For those of you considering these options, it’s crucial to proceed with caution and consult healthcare providers who can guide treatment choices based on the latest and most reliable evidence.

Heart Palpitations and Magnesium Supplementation

While magnesium is important for overall cardiovascular health and normal heart rhythm, current scientific evidence does not support the use of magnesium supplementation to reduce heart palpitations in individuals without a diagnosed arrhythmia. Magnesium may offer benefits for reducing symptoms of anxiety and improving sleep quality, which could indirectly help some people feel fewer palpitations. However, these potential effects are not well-established, and there is a lack of substantial scientific data to recommend magnesium supplementation specifically for reducing palpitations in such cases.

Instant ECG Feedback and the Power of Bodily Awareness: Exploring Its Potential in Managing Heart Palpitations

The adoption of instant electrocardiogram (ECG) feedback has shown promising results in managing heart palpitations, especially for women who may suffer from increased anxiety and a reduced quality of life due to these symptoms. Observational studies by Carnlöf et al. in 2021 have shed light on how this technology could potentially help in the treatment of palpitations.

Insights from the Observational Studies:

1. Reduction in Anxiety and Depression: These studies found that instant ECG feedback significantly reduces anxiety and depression in women experiencing palpitations. This effect is likely due to the immediate reassurance that their heart rhythm is normal or benign, alleviating the psychological distress from uncertainty about their symptoms.
2. Improvement in Health-Related Quality of Life (HRQOL): The feedback from ECG monitoring has shown to enhance HRQOL across all domains for women with palpitations. This significant improvement tackles both the physical sensations of palpitations and the emotional reactions, enhancing overall wellbeing.
3. Symptom Frequency and Severity: The application of instant ECG feedback has been observed to decrease both the frequency and severity of palpitations. The instant reassurance provided likely helps individuals manage their reactions to palpitations more effectively.
4. Detection of Benign Arrhythmias: A large majority of the palpitations recorded in these studies were identified as benign arrhythmias, such as premature atrial or ventricular contractions or sinus tachycardia. This finding is crucial as it helps reduce unnecessary anxiety over heart health when palpitations are not a marker of severe conditions.

Connecting the Dots: My Thoughts on Mind-Body Approaches to Heart Palpitations

The value of instant ECG feedback in the studies by Carnlöf et al. extends beyond the immediate relief it offers. This technology essentially serves as a mirror, reflecting back the reality of your physiological state in real-time. When you see that your heart rhythm is normal during a palpitation episode, it can immediately alleviate the fear and anxiety surrounding the experience. This reassurance is powerful—it not only diminishes stress but also interrupts the cycle of anxiety that palpitations often exacerbate.

This real-time feedback loop provided by instant ECG devices helps in cultivating a nuanced understanding of your body’s signals. It teaches you to correlate what you feel with what is actually happening, an exercise in enhancing interoceptive accuracy. Over time, this practice can lead to a more informed and relaxed response to palpitations.

I find myself drawn to a deeper concept that resonates profoundly with my experiences and observations—the idea of interoception. Interoception is the ability to perceive and understand the internal signals of your body. It’s about being attuned to your heartbeat, breath, and other physiological processes and interpreting these sensations accurately.

In my own experience and in our community, I’ve seen how not knowing what’s happening inside your body can amplify anxiety. When you feel a sudden flutter or racing heartbeat, it’s natural to worry. This uncertainty can create a feedback loop where anxiety exacerbates the physical symptoms, leading to more anxiety—a cycle that’s tough to break.

This is where learning to listen, decipher, and regulate your own physical and emotional responses becomes incredibly powerful. By becoming more aware of your body’s signals, you can start to differentiate between benign sensations and those that may require medical attention. Instant ECG feedback provides a tangible way to see what’s happening in your heart at the moment you experience palpitations. This immediate insight can alleviate the fear of the unknown, reducing anxiety and, in turn, the frequency of palpitations.

But beyond technology, I believe there’s immense value in cultivating a deeper connection with your body through mindfulness and self-awareness practices. The essence of these practices is to attune to your body and emotions with curiosity and without judgment. By consistently engaging with your body’s sensations in this mindful way, you can more effectively regulate your responses to stress and anxiety.

For instance, when a palpitation occurs, instead of immediately spiraling into worry, you might take a moment to pause, breathe deeply, and observe the sensation. Acknowledge it without judgment or fear. This mindful approach can help calm your nervous system, potentially reducing the intensity and duration of the palpitation.

In essence, while tools like instant ECG feedback can be incredibly helpful, they are most effective when combined with a personal commitment to self-awareness and emotional regulation. I strongly believe that empowering yourself to understand and interpret your body’s signals not only helps in managing palpitations but also contributes to overall well-being.

Other Behavioral and Mind-Body Interventions

In their systematic review, Sheng et al. (2021) explored the potential of behavioral and mind-body interventions for managing palpitations. The review highlighted promising results, such as a study that found a decrease in palpitations following Cognitive-Behavioral Therapy (CBT). Another study showed that combining psychological interventions with Chinese herbal treatments was even more effective than either approach alone. Additionally, a single study on auricular acupressure demonstrated a reduction in palpitations severity after just four weeks of treatment. While these findings are certainly encouraging, it’s important to note that the authors emphasized the need for more high-quality, well-designed studies before fully recommending these treatments for palpitations.

In addition to these promising avenues, a 2016 randomized controlled trial by Owens et al. looked specifically at the impact of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on individuals suffering from palpitations. The results were promising—patients experienced significant improvements in autonomic balance, suggesting that mindfulness practices like meditation and stress reduction can have a real, positive effect on palpitations. What’s compelling here is that this isn’t just about managing stress; it’s about creating physiological changes that directly influence the heart. While more research is necessary, it’s exciting to see the growing body of evidence that stress reduction techniques may play a critical role in reducing palpitations.

A Comprehensive Approach to Managing Palpitations: Recommendations

For individuals experiencing palpitations, particularly women navigating perimenopause and menopause, it’s critical to adopt a multifaceted approach. While palpitations are often benign, they can be distressing and, in some cases, indicate underlying hormonal or cardiovascular issues.

Here’s my final thoughts on how to manage palpitations, integrating current evidence, practical recommendations, and mind-body strategies.

1. Evaluate Hormonal Status and Heart Health

Palpitations during perimenopause and menopause are not uncommon and may be influenced by hormonal fluctuations. If you’re a woman over the age of 35 experiencing palpitations, it’s essential to have both your hormonal levels and heart health evaluated. The cardiovascular system and hormonal balance are intricately linked during menopause, and fluctuations in estrogen, for example, can trigger palpitations or exacerbate their frequency.

• Self-advocacy is key: Many women report that discussions about menopause-related symptoms, such as palpitations, are often minimized or dismissed in clinical settings. It is crucial to be informed and persistent. Advocate for comprehensive testing, including hormone panels and cardiovascular assessments.
• Hormone Replacement Therapy (HRT): Hormone Replacement Therapy is currently the only treatment for menopausal palpitations that is supported by research, although further studies are needed to fully understand its impact. For many women, palpitations during perimenopause and menopause are linked to fluctuations in hormone levels, particularly estrogen. HRT works by stabilizing these hormone levels, which can help reduce the frequency and intensity of palpitations. For some women, HRT will be a key element in getting symptoms under control, particularly when other interventions, such as lifestyle changes, don’t provide sufficient relief. It’s important to approach HRT under the guidance of a healthcare provider, as the therapy must be tailored to individual needs. For women who experience significant palpitations related to hormonal changes, HRT may offer the most reliable solution currently available, making it an important consideration in the management of menopausal symptoms.

2. Mind-Body Approaches for Palpitations

Integrating mind-body interventions can have a significant impact on both the emotional and physical symptoms of palpitations. Research indicates that approaches which promote greater awareness and regulation of bodily cues can help reduce the frequency and intensity of palpitations, while also addressing the associated anxiety.

• Mindfulness-Based Stress Reduction (MBSR): Engaging in MBSR, which combines mindfulness with somatic interventions, has been shown to improve heart rate variability (HRV)—a key marker of cardiovascular health—and reduce palpitations. MBSR promotes parasympathetic (rest and digest) activation, which can counter the stress-induced “fight or flight” response often linked to palpitations.
• Somatic practices and Breathwork: Specific physical practices that emphasize deep, controlled breathing can directly influence the nervous system and reduce stress-related palpitations. Research shows that regular yoga practice can help improve autonomic regulation, which is vital for reducing the sensations of heart irregularities.
• Instant ECG Feedback: For individuals who find palpitations especially distressing, using handheld ECG devices can be helpful. Studies show that real-time ECG feedback not only reduces the severity of palpitations but also alleviates anxiety and depression related to these symptoms. The immediate reassurance provided by seeing normal heart rhythms can reduce the emotional impact of palpitations.

3. Stress Management and Nervous System Regulation

Stress is one of the most common triggers for palpitations. Chronic stress can disrupt cortisol patterns, which in turn affects the cardiovascular system and can provoke palpitations. Addressing stress through proactive regulation of the nervous system is critical in managing both the frequency and severity of palpitations.

• Nervous System Regulation: Techniques such as biofeedback, progressive muscle relaxation, and guided imagery can help you gain better control over the body’s response to stress. These techniques not only reduce palpitations but also improve emotional well-being by stabilizing the sympathetic nervous system (the system that triggers the fight-or-flight response).
• Exercise: Regular physical activity, particularly aerobic exercise, is known to reduce stress and regulate the hypothalamic-pituitary-adrenal (HPA) axis, which plays a critical role in stress management. Exercise also promotes a healthier circadian rhythm, improving cortisol balance and reducing stress-related palpitations. However, it’s essential to tailor exercise intensity to your body’s current condition, as over-exercising can sometimes trigger palpitations in susceptible individuals.

4. Emotional Regulation and Coping Strategies

Palpitations are often accompanied by emotional symptoms, such as anxiety or panic, especially when they arise unexpectedly. Developing tools for emotional regulation is crucial for managing the stress that often triggers or worsens palpitations.

• Cognitive-Behavioral Therapy (CBT): CBT is effective in addressing the emotional responses that may escalate palpitations. By learning to regulate anxious thoughts and adopting healthier coping mechanisms, you can break the cycle of stress-induced palpitations.
• Emotional Awareness and Resilience Training: Practices that encourage emotional awareness, such as emotional resilience training and acceptance-based therapies, can help individuals develop a more adaptive response to stressful situations. This reduces the likelihood of stress triggering physical symptoms like palpitations.

5. Supplemental Support: Complementary, Not Primary

While lifestyle and mind-body interventions should be the foundation of your strategy for managing palpitations, some people find that certain supplements provide additional support. It’s important to note, however, that the evidence for supplements like Siberian rhubarb (Rheum rhaponticum), isoflavones, and sage is not strong enough to recommend them as primary treatments.

• Siberian Rhubarb (ERr 731): Some studies suggest that Siberian rhubarb may help reduce vasomotor symptoms (like hot flashes and night sweats), but the evidence supporting its effect on palpitations is not conclusive. Rigorous, well-designed clinical trials are still needed before any definitive recommendations can be made.
• Other Supplements: Isoflavones and phytoestrogens have shown mixed results, with some trials indicating a benefit and others finding no significant effect. Similarly, herbal supplements like sage and Tribulus terrestris may provide some relief, but the current evidence base is too weak to make strong recommendations. Always consult a healthcare provider before adding any supplement to your regimen, as interactions with medications or hormonal therapies can occur.

Final Thoughts

For those experiencing palpitations, addressing both physical and emotional health is essential. A comprehensive approach includes:

• A thorough evaluation of hormonal and cardiovascular health to assess any underlying issues, with HRT being the only treatment currently supported by research, offering effective relief for some women.
• Incorporating mind-body practices like nervous system regulation, MBSR, yoga, and instant ECG feedback to enhance body awareness, regulate stress, and alleviate symptoms.
• Proactively managing stress through regular physical activity, mindfulness, and nervous system regulation techniques to stabilize cortisol levels and improve overall well-being.
• Working on emotional regulation through therapies like mindfulness and CBT to manage the emotional triggers that can intensify palpitations.
• Using supplements cautiously, as a complementary measure to lifestyle changes, and only in consultation with your healthcare provider due to limited evidence.

References:

1. Sheng, Y., Carpenter, J., Elomba, C., Alwine, J., Yue, M., Chen, C., & Tisdale, J. (2021). Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric, 25, 128 – 140. https://doi.org/10.1080/13697137.2021.1948006.
2. Carnlöf, C., Schenck-Gustafsson, K., Jensen-Urstad, M., & Insulander, P., 2021. Instant electrocardiogram feedback with a new digital technique reduces symptoms caused by palpitations and increases health-related quality of life (the RedHeart study).. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. https://doi.org/10.1093/eurjcn/zvaa031.
3. Carnlöf, C., Insulander, P., Jensen-Urstad, M., & Schenck-Gustafsson, K., 2019. 2202Instant analysis of the ECG with a new digital technique during palpitations reduce symptoms, anxiety, depression, and increase HRQOL in women. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz748.0106.
4. Owens, J., Schorling, J., Plews-Ogan, M., Goodman, M., Moorman, R., Zaklin, R., & Dent, J., 2016. A randomized controlled trial evaluating Mindfulness-Based Stress Reduction (MBSR) for the treatment of palpitations: A pilot study.. International journal of cardiology, 223, pp. 25-27 . https://doi.org/10.1016/j.ijcard.2016.08.183.
5. Carpenter, J. S., Sheng, Y., Elomba, C., Alwine, J., Yue, M., Pike, C., Chen, C., & Tisdale, J. (2021). A Systematic Review of Palpitations Prevalence by Menopausal Status. Current Obstetrics and Gynecology Reports, 1-7. https://doi.org/10.1007/s13669-020-00302-z.
6. Carpenter, J. S., Tisdale, J. E., Larson, J., Sheng, Y., Chen, C. X., Ah, D., Kovacic, T., Reed, S. D., Thurston, R. C., & Guthrie, K. A. (2022). Correlates of palpitations during menopause: A scoping review. Women’s Health, 18. https://doi.org/10.1177/17455057221112267.
7. Carpenter, J., Tisdale, J., Larson, J., Sheng, Y., Chen, C., Ah, D., Kovacs, R., Reed, S., Thurston, R., & Guthrie, K. (2021). MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women. Menopause, 29, 144 – 150. https://doi.org/10.1097/GME.0000000000001897.
8. Sheng, Y., Carpenter, J., Elomba, C., Alwine, J., Yue, M., Chen, C., & Tisdale, J. (2021). Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric, 25, 128 – 140. https://doi.org/10.1080/13697137.2021.1948006.