The Case:  Erica is 37 and was experiencing fast and loud heart palpitations without provocation. These episodes became more frequent causing Erica to fear the worst. She saw several cardiologists who insisted that nothing was wrong.  A racing heart or heart palpitations are described in many ways. Some might say, ‘my heart is beating out of my chest,’ or ‘my heart skipped a beat’. It can also be described as being able to feel your heartbeat in your ears, or like it’s banging against your rib cage. You might even feel like you can’t catch your breath.  However you describe it, it’s scary. We get used to not really noticing our heartbeat - to just knowing that it’s in there, doing its job. So, when we suddenly feel it, we worry that something must be wrong. In some cases, heart palpitations can be a sign of a more serious issue so Erica was right to see her doctor and a cardiologist first.  However, when she came to me with no answers from those specialists, I knew we had to dig a little deeper to get to the root cause of these frightening and erratic heart palpitations.    The Investigation The heart is very responsive to other types of stimulation. When you see a cardiologist, they generally don’t have a lot of time to look into these other causes. Understandably, they focus on major issues or events that are life threatening and if those are not the cause, they may dismiss your concerns as ‘nothing’. But, that doesn’t stop them from happening or make you feel any better about it when it does happen.  Luckily, some cardiologists go beyond the ‘it’s not a heart attack’ diagnosis to get curious about what’s actually going on. One such cardiologist is Dr Christopher Kelly. He practices at the North Carolina Heart and Vascular (part of UNC Health) and is the co-author of the book, Am I Dying?!: A Complete Guide to Your Symptoms--and What to Do Next. I was thrilled to invite him in to discuss Erica’s case.    Could it be a Heart Condition? We know in Erica’s case it wasn’t but how likely for a fairly healthy 37 year old to have a heart condition? Dr. Kelly says that without a pre-existing condition (that you may have been born with) it’s unusual to see heart disease in people under 50. However, he’s seeing a trend where the average age of his patience is getting younger. He attributes this to the American lifestyle which is making people sicker, sooner.    What are Heart Palpitations?  Dr. Kelly describes heart palpitations as an extra beat or a skipped beat,  a racing heartbeat, or your heart beating hard enough that you notice it. Generally this is without explanation. For example, we know that when we are working out or running, we are going to feel our heart beat faster. Or, if we have a scare or we’re understandably nervous, then we know why our heart might be racing. However, heart palpitations can seem to come out of nowhere and for no apparent reason. This is why they are so disconcerting.    How Common are Heart Palpitations? Having a spontaneous, unprovoked heart palpitation occasionally is very common. However, when it seems to be happening regularly, without explanation, this is not common and should have you seeking professional help. The first thing you want to do is rule out that these heart palpitations are not related to heart disease.   What Causes Heart Palpitations? When a heart condition is ruled out, there are several other places that we can look to find a cause for heart palpitations. The heart is very sensitive to a lot of inputs. One of the inputs to the heart is adrenaline which is the fight or flight hormone. We release adrenaline when we are scared, nervous, or excited but we can also release it when we are stressed or experiencing anxiety. In some cases, we may not be fully aware that we are in a state of stress or anxiety but the adrenaline is released anyway which is what can cause the seemingly unexplained heart palpitations.    Heart Palpitations May Be a Side Effect Certain medications may ca