Now that COVID-19 has been part of our lives for several years, we’re learning more about how the virus affects the body — both in the short term and over time. But there are still many things healthcare providers don’t know. This is especially true of the impact COVID-19 can have on heart health.

We talked to a cardiologist to learn more about what palpitations are, why people frequently experience this cardiac symptom during and after COVID-19 infection, and what to do about them.

What are heart palpitations?

Let’s start with the basics. Heart palpitations are a sensation that something about your heart rhythm is off — which may or may not actually be the case. You may experience any of the following:

• Skipping heartbeats.

• Extra heartbeats.

• Pounding unusually hard.

• Fluttering.

• “Flip-flopping.”

Palpitations are common — and frequently harmless. You could experience them when you’re stressed, when you’ve had too much caffeine or when you take certain medications. You can even get them by eating spicy food!

Cardiac arrhythmia, or an irregular heartbeat, can cause heart palpitations. But that’s not always the situation. “Palpitations are such a broad symptom,” says cardiologist Tamanna Singh, MD. “It’s often hard to determine whether palpitations are related to arrhythmia.” 

While palpitations themselves aren’t usually concerning, they can be a sign of trouble if they’re accompanied by other symptoms, like a rapid heartbeat (tachycardia), dizziness, shortness of breath or chest pain. These are symptoms many people also experience while ill with COVID-19. They’re also common symptoms of certain kinds of heart disease.

And that, dear reader, is why this topic is so complicated.

Can COVID-19 cause heart palpitations?

We don’t know if COVID-19 causes heart palpitations or not, in part because there are so many reasons people experience palpitations.

“There are a lot of confounders,” Dr. Singh says. “For example, let’s say you just had COVID and are feeling a lot of brain fog and are really tired. So, you drink a lot of coffee and caffeine. That can trigger palpitations that are completely unrelated to COVID. It’s the same thing with sleep. Poor sleep and dehydration can trigger palpitations.”

As you may imagine, this makes conversations about cause and effect difficult.

“‘Palpitations’ is a big word with a lot of potential causes. And what doctors have to do is figure out if your specific palpitations are harmful or not,” Dr. Sigh continues.

In order to do that, healthcare providers have to conduct a rhythm assessment. That helps them determine if the palpitations are a symptom of a cardiac arrhythmia or the run-of-the-mill palpitations that — while certainly unnerving for the person experiencing them — aren’t due to a medical issue.

“It’s tricky, because telling someone that you understand they’re having real symptoms, but there’s no objective data to define those symptoms — it can be hard for them to swallow.” Dr. Singh recognizes. “In those cases, we talk about making sure that we’re on top of potential triggers, like hydration status and sleep, adequate recovery and nutrition, avoiding caffeine and alcohol, things like that.”

Heart palpitations after COVID-19

While we can’t say for sure that COVID-19 causes palpitations, we do know that heart complications are common features of post-COVID syndrome, which you can get even if your symptoms were minor.

But in most of the cases, Dr. Singh is seeing the cardiac symptoms aren’t necessarily a sign that something’s wrong with the structure or function of the heart. Instead, they may be a sign of deconditioning and/or dysregulation of the sympathetic and parasympathetic nervous systems, also known as autonomic dysfunction.

That’s a mouthful, so let’s break it down.

Your autonomic nervous system, simply put, governs the actions your body does automatically. You don’t regulate your blood pressure or heart rate by thinking about them — your body does it for you. If you have autonomic dysfunction, something about the way your nervous system is managing one (or several) of these processes is off. In other words, it’s a neurological issue, not a heart issue, lung issue, etc.

“With post-COVID syndrome, we suspect there may be underlying autonomic dysfunction, which is neurological,” Dr. Singh says.

Some cases of high heart rates may be due to inappropriate sinus tachycardia, which Dr. Singh explains happens “when you have high heart rates while you are at rest, but a normal rhythm coming from the sinus node, which is kind of like your internal pacemaker.” Other cases of high heart rates may simply be a normal physiologic response to losing fitness during and after an illness.

“In both cases, people whose resting heart rate may have been in the 50s or 60s to begin with continue like that when they’re at rest, but as soon as they move to put on a sweater, or walk across a room, their heart rate jumps up to the 130s and 140s,” she notes. “Even just a high heart rate with a normal rhythm can lead to palpitations.”

It’s important to keep in mind that post-COVID syndrome is even newer than COVID-19. “Post-COVID syndrome was defined in late 2020, early 2021,” Dr. Singh says. “If you think about it, we’ve only been dealing with these long-haul symptoms for a while. So, it’s hard to say whether palpitations that are related to COVID will last for a couple of weeks, a couple of months, or years.

“I’ve seen some patients whose symptoms wax and wane. It’s a testament to the fact that we just don’t know why there’s such a wide spectrum of symptom severity with both COVID and post-COVID.”

In Dr. Singh’s experience, most people who experience palpitations during or after a COVID-19 infection do see their palpitations resolve. But the “when” is hard to predict.

Dr. Singh is also quick to note that COVID-19 can cause other problems that look like arrhythmia. So, while palpitations aren’t necessarily a cause for alarm, you need to see a doctor to rule out other problems.

Can you get palpitations from the COVID-19 vaccine?

We asked Dr. Singh if it’s common to experience cardiac symptoms in the aftermath of a COVID-19 vaccine or booster.

“I have not seen anyone develop heart palpitations from the COVID vaccine that led to deadly heart rhythms,” Dr. Singh says, adding “I encourage people to get vaccinated because it’s quite possible to develop heart problems with COVID, like myocarditis, that can lead to sudden cardiac arrest or death.”

In other words, being unvaccinated is much more dangerous for your heart than the vaccine.

“If people do have side effects from the vaccine, we would do extensive testing,” Dr. Singh says, “but I haven’t seen any major abnormalities.”

What to do if you have palpitations during or after COVID-19 infection

First things first: If you’re experiencing palpitations, you should contact a doctor. It’s important they check your heart to make sure there aren’t any underlying issues with it that might be causing your symptoms. If you do have other issues, your cardiologist will put you on medication.

It’s also important to get evaluated if you aren’t feeling right. “The last thing we want is for you to sit there for a couple of days worrying, and we miss what’s going on,” encourages Dr. Singh. “It’s better to be safe than sorry.

“If you’re suddenly experiencing other symptoms alongside your palpitations — things like feeling short of breath, lightheaded or dizzy, or if you’re passing out or experiencing chest discomfort, go to the emergency room or go to urgent care. You can always call your primary care physician or your cardiologist if you have one, but you need to be seen quickly.”

If your palpitations aren’t a sign of a more serious medical condition, then there are things you can do, with your doctor’s support, to get a handle on them and — hopefully — get rid of them.

If you’re actively ill with COVID-19

If palpitations are one of the symptoms you’re experiencing while sick with COVID-19, rest and hydration are key.

• Rest your heart, respect the virus. That means avoiding moderate to high-intensity exercise. According to Dr. Singh, exercising too hard could aggravate any inflammation you’re experiencing and provoke arrhythmias.

• Replenish electrolytes, especially if you’re experiencing lightheadedness, too. Electrolytes are important for regulating nerve, muscle and brain function, as well as blood flow. They also help regulate how much water stays in your cells. Remember: Dehydration is a common trigger for palpitations.

What to do after COVID-19

COVID-19 is a serious virus. If you experience palpitations during your recovery — or if you’ve been diagnosed with post-COVID syndrome — it’s important to make your doctor aware of what’s happening.

Talk to your doctor about supplements

“Sometimes, people with heart palpitations feel better when they take omega supplements because it helps fight inflammation,” Dr. Singh notes. It’s also common for healthcare providers to recommend calcium, potassium and magnesium supplements to people who are experiencing palpitations.

But remember, supplements aren’t always a good idea, so it’s important to speak to a provider before starting anything. Not only can they figure out what will best meet your needs, but they can also make brand and dosage recommendations.

Start exercising again … but take it slow

It seems counterintuitive, but exercise improves heart rate variability and autonomic balance.

“It can be challenging to tell post-COVID patients who feel awful — who can’t even walk out of their house without feeling short of breath or winded — to go exercise,” Dr. Singh admits. “But exercise actually can help mitigate those symptoms and bring back that heart rate balance.”

She encourages people who’ve had COVID-19 to focus on consistency and intensity. “If you can only do two or three minutes at a time, that’s OK. Just make sure you aggressively hydrate before, during and after and take a recovery day. Try to improve your endurance over a couple of weeks, eventually building up to 30 to 45 minutes at a time. And then, if you’re feeling well, you can talk about upping the intensity.

“Something that happens to a lot of people with COVID is that they become really deconditioned,” she continues. “A lot of these symptoms we’re seeing may also be the result of bed rest and being deconditioned for weeks.” Whatever the cause, exercise is likely part of the solution.

When in doubt, talk to your doctor

Being aware of your heartbeat can be scary, especially if you’re already dealing with COVID-19 and its aftermath. The good news is you’re not alone. Healthcare providers and researchers are working hard to understand why these cardiac symptoms are happening and have a lot of tools at their disposal to help you manage yours. 

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