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In my practice as a clinical psychologist, I often hear patients complain about their heart skipping beats when they are anxious or under stress. People panic and imagine that they are having a heart attack, thus triggering even more anxiety. Who should they see in this situation? A family doctor, a cardiologist, or a psychologist? The answer: it depends. Let's go behind the scenes and into the curious world of medical training. One of the first things medical students learn is: In an emergency, take your own pulse first!  

We are speaking figuratively here, but sometimes you should take it…literally. The message is "get calm, stay calm," so you can think clearly about the best action to take. That's a high priority if you feel your heart is skipping beats, throwing in extra beats, or is racing - take your pulse. It's important for two reasons. The first reason is that remaining calm helps with mental clarity; the second is that this information is needed by your doctor when you call.  

Heart palpitations are the feeling of rapid fluttering or pounding heartbeats. The palpitations are the most common cause of what people describe as the heart skipping beats, though palpitations can feel like there are skipped beats or extra beats thrown in. Palpitations are often triggered by anxiety, stress, exercise, caffeine, nicotine, and medications such as decongestants and cold medicines. Illegal stimulants, such as cocaine, crack, or crank, are toxic to the heart muscle. These can cause not just palpitations but also lead to death. Palpitations are rarely triggered by heart disease, but you can't afford to ignore them on the rare occasions that it occurs.  

Now that you've checked your pulse, there are three things to quickly assess. Medical students are taught a helpful acronym to assess the urgency of an unexpected, potentially threatening situation, it is "ABC". A is for ALERT. Is the person alert? Palpitations may cause mild lightheadedness or dizziness, but should not cause confusion or loss of consciousness (fainting). Those are an emergency. B is for BREATHING. Palpitations can cause slight shortness of breath, but if the person is so short of breath that they can't carry on a conversation, that's an emergency. C is for CHEST PAIN. If there is any chest pain with the palpitations, it is an emergency. If one of the emergency indicators is present, it is best to call 911. 

Learn the ABCs. You can employ the acronym across many situations and medical emergencies that you encounter.  

The next few things to assess are potential risk factors that, if present, increase the likelihood that treatment is urgent. The elderly, people with underlying heart disease, chronic diseases like diabetes, lupus, kidney disease, cancer, hyperthyroidism, and others, maybe too frail to tolerate the palpitations and can quickly deteriorate. Pregnant women experiencing palpitations should be seen by a doctor. 

Potential complications include: 

• Fainting - because a very fast heart rate can cause blood pressure to drop. 
• Cardiac arrest - palpitations caused by a life-threatening abnormal rhythm prevents the heart from pumping well. 
• Stroke - palpitations can make parts of the heart quiver, allowing blood clots to form in the heart. If a clot breaks loose, it can block a blood vessel in the brain and cause a stroke. 
• Heart Failure - if your heart doesn't pump well over a long period of time. 

If you only have a few palpitations from time to time, and you’re otherwise in good health, they’re usually of little consequence. However, if they become increasing in frequency or duration, immediately see your doctor. If any of the previously described risk factors are present, visit your family doctor. If necessary, the family doctor will refer you to a cardiologist.  

When reasonable measures are taken to rule out heart disease as the cause of the palpitations, then it is safe to consider the most common cause of palpitations - anxiety. It's normal to feel anxious or nervous at times, but if you experience anxiety every day that is hard to control and interferes with your quality of life, you may have a generalized anxiety disorder. Along with palpitations, some people with anxiety experience headaches, back pain, sweating, nausea, and stomach problems. If that is the case, you should see a mental health professional such as a clinical psychologist or psychiatrist. 

Many life events can trigger anxiety disorders. A troubled marriage, dysfunctional family relationships, financial hardship or job problems can all trigger anxiety. When you feel this way, taking a walk might help; it has a natural calming effect. Try calling a friend. The familiar, friendly voice is soothing and a conversation can distract your mind.