Based on PubMed | Can COPD cause heart palpitations, and when should I seek medical attention for them?

COPD can be linked to heart palpitations in several ways, and it’s wise to pay attention to them because some can signal an underlying heart rhythm problem or a COPD flare. Palpitations are the sensation that your heart is beating fast, fluttering, thumping, or skipping beats, and they can occur at rest or with activity. ^[1]

How COPD can lead to palpitations

• COPD is associated with a higher risk of heart problems, including heart disease and arrhythmias (irregular heartbeat), which can present as palpitations. ^[2]
• Irregular heartbeat specifically is noted among the non‑lung complications of COPD, along with chest pain and heart failure, and these rhythm problems can produce palpitations. ^[3]
• In COPD, changes in oxygen and carbon dioxide levels, acid–base balance (pH), and electrolytes can provoke arrhythmias; these mechanisms are especially relevant during acute respiratory failure or flares. ^[4]
• Arrhythmias in COPD can also be triggered by cor pulmonale (strain on the right side of the heart due to lung disease) or coexisting coronary artery disease. ^[4]
• Irritation of airway receptors from coughing or mechanical airway devices can trigger rhythm disturbances, which may be felt as palpitations. ^[5]
• Systemic inflammation and oxidative stress seen in COPD may contribute to a higher frequency of cardiac arrhythmias independent of shared risk factors like age and smoking. ^[6]

Role of COPD medicines

• Some inhaled bronchodilators, especially beta‑agonists (short‑ and long‑acting), can cause palpitations, rapid heart rate, tremor, or nervousness as known side effects. ^[7]
• Combination inhalers that include a beta‑agonist list palpitations and rapid heart rate among expected adverse effects, and users are advised to discuss new or worsening symptoms with a clinician. ^[8]
• In clinical trials of long‑acting beta‑agonists used in COPD, serious arrhythmias like atrial fibrillation or sustained ventricular tachycardia were infrequent and did not increase compared to placebo; however, atrial tachycardia was common at baseline and increased slightly (about 2–5%) with therapy. ^[9]

How common and how serious?

• COPD is linked to a wide variety of arrhythmias, some clinically significant or even life‑threatening, particularly during acute respiratory failure; close monitoring can be helpful to detect and assess them. ^[4]
• Arrhythmias associated with COPD can worsen oxygenation and generally indicate a more serious prognosis if they occur during severe flares. ^[10]
• Resting heart rate tends to be higher as COPD severity increases, and a higher resting heart rate is independently associated with higher all‑cause and cardiovascular mortality in COPD. ^[11]
• In older adults with COPD, every 10‑beat‑per‑minute increase in resting heart rate was associated with a 21% higher risk of death, suggesting palpitations and persistently fast pulse merit attention. ^[12]

When to seek medical attention

• If palpitations are brief and infrequent, they may not require urgent evaluation, but frequent or worsening palpitations especially if you have known heart disease should be discussed with a healthcare professional. ^[1]
• Seek emergency care immediately if palpitations occur with chest pain, fainting, severe shortness of breath, or marked lightheadedness, as these symptoms can signal a dangerous rhythm or heart problem. ^[13]
• If palpitations come with shortness of breath, chest pain, dizziness, sweating, or you feel unwell, you should seek help right away; an irregular or very fast pulse or any fainting also warrants prompt medical assessment. ^[14]
• Rapid heartbeats (tachycardia) accompanied by chest discomfort, shortness of breath, weakness, dizziness, or fainting should prompt immediate medical attention. ^[15]

Practical steps you can take

• Track episodes: note timing, duration, triggers (like inhaler use, caffeine), associated symptoms (shortness of breath, chest pain), and measured pulse; this helps your clinician evaluate the cause. ^[1]
• Review inhaler technique and timing with your clinician, as overuse or incorrect use of beta‑agonist inhalers can increase palpitations; sometimes adjusting the regimen reduces symptoms. ^[7]
• Check for contributors such as dehydration, excessive caffeine, certain decongestants, or missed COPD medications; managing these may lessen palpitations. ^[1]
• Ask about heart monitoring (like ECG or ambulatory monitors) if palpitations are frequent; long‑term monitoring increases detection and guides treatment when arrhythmias are suspected in COPD. ^[4]
• Optimize COPD control to stabilize oxygen and carbon dioxide levels, as improving ventilatory status is a core part of treating arrhythmias linked to COPD physiology. ^[4]
• Discuss whether your resting heart rate is persistently high and whether heart‑rate–lowering strategies are appropriate in your case, since higher resting heart rate is linked with worse outcomes in COPD. ^{[11] [12]}

Summary

• COPD can be associated with palpitations through increased risk of arrhythmias and the effects of abnormal blood gases, pH, and medications like beta‑agonists. ^{[4] [7]}
• Many palpitations are benign, but those that are frequent, worsening, or accompanied by chest pain, shortness of breath, dizziness, or fainting deserve urgent medical evaluation. ^{[13] [14]}
• Managing COPD well, reviewing inhaler use, and seeking appropriate heart monitoring can help identify the cause and reduce the risk from palpitations. ^{[4] [9]}