Based on NIH | Are heart palpitations a recognized symptom in people with Crohn's disease, and what mechanisms or complications could explain their occurrence?

Heart palpitations are not considered a core or typical symptom of Crohn’s disease, but they can occur in people with Crohn’s for several plausible reasons and associated complications. ^[1] Crohn’s primarily causes digestive symptoms such as diarrhea, abdominal pain, and weight loss, with additional systemic features like anemia, fatigue, fever, joint pain, and skin or eye involvement, rather than primary heart rhythm symptoms. ^{[1] [2]}

How Crohn’s Could Lead to Palpitations

• Anemia from chronic inflammation or blood loss: Low red blood cell levels reduce oxygen delivery and can make the heart beat faster or feel irregular as it compensates, which may be felt as palpitations. ^[1]
• Electrolyte disturbances from diarrhea or malabsorption: Ongoing diarrhea and reduced nutrient absorption can lower potassium, magnesium, or calcium, which are essential for normal heart rhythm, potentially triggering fluttering or racing beats. ^[1]
• Dehydration and low blood volume: Diarrhea and reduced oral intake can cause dehydration, prompting a reflex increase in heart rate that can be perceived as palpitations. ^[1]
• Systemic inflammation and autonomic imbalance: Inflammatory bowel disease has been associated with autonomic nervous system dysfunction (the body’s automatic “brake and accelerator” for heart rate), which may alter heart rate variability and contribute to the sensation of palpitations even when the heart is structurally normal. ^{[3] [4]}

Less Common but Important Cardiac Links

• Medication-related effects: Certain therapies sometimes used in Crohn’s (for example, steroids or biologics in rare instances) can contribute to fluid shifts, blood pressure changes, or, rarely, rhythm issues, which may be experienced as palpitations. While these effects are not universal, medication side effects are a recognized pathway for cardiac rhythm changes in various treatment contexts. ^[5]
• Inflammation of the heart (myocarditis or pericarditis): Although uncommon in Crohn’s, inflammatory conditions of the heart muscle or surrounding sac can cause chest discomfort, shortness of breath, and palpitations. ^[6]
• Increased risk of blood clots: Crohn’s is associated with a higher tendency for venous and arterial thrombosis; if a clot affects the lungs (pulmonary embolism), it can cause sudden rapid heart rate and palpitations along with chest pain or breathlessness, which is an emergency. ^[7]

What the Evidence Emphasizes

• Core symptom lists for Crohn’s do not include palpitations, underscoring that palpitations are not a hallmark of the disease itself. ^{[1] [2]}
• Autonomic dysfunction is documented in inflammatory bowel disease, including Crohn’s, with reduced heart rate variability and signs of autonomic neuropathy reported, which provides a biologically plausible link to altered heart rate sensations. ^{[3] [4]}
• Inflammatory and systemic complications (anemia, dehydration, electrolyte loss) are common in Crohn’s and directly affect cardiac rhythm and perception of heartbeat. ^[1]

Red Flags and When to Seek Care

• Seek urgent care if palpitations are accompanied by chest pain, fainting, severe shortness of breath, or signs of a blood clot (sudden chest pain, coughing blood, one-sided leg swelling), as these can indicate serious conditions like myocarditis, arrhythmia, or pulmonary embolism. ^{[6] [7]}
• Discuss persistent palpitations with your clinician, especially if you have active diarrhea, weight loss, or fatigue, since treating anemia, dehydration, or electrolyte imbalances often alleviates palpitations. ^[1]

Practical Evaluation and Management

• Check basics first: A complete blood count for anemia, metabolic panel for electrolytes (especially potassium and magnesium), kidney function, inflammatory markers, and hydration status can uncover common, fixable causes. ^[1]
• Assess Crohn’s activity and nutrition: Flare control, adequate fluid intake, and nutrition support can stabilize heart rate by correcting volume and electrolyte shifts. ^[1]
• Cardiac assessment when indicated: If palpitations persist or are severe, an ECG, ambulatory monitor (Holter), and, where appropriate, echocardiogram can evaluate for arrhythmia or myocarditis/pericarditis. ^[6]
• Medication review: Ask about recent dose changes or new therapies; consider alternatives if a drug temporally correlates with new palpitations. ^[5]

Bottom Line

• Palpitations are not a primary symptom of Crohn’s, but they can happen due to Crohn’s-related complications most often anemia, dehydration, and electrolyte abnormalities or less commonly due to autonomic dysfunction, medication effects, and rare cardiac inflammation. ^{[1] [2] [3] [4] [6] [5]}
• Addressing the underlying Crohn’s activity and correcting systemic factors usually improves palpitations, while red‑flag features warrant prompt cardiac evaluation. ^{[1] [6] [7]}