Multiple sclerosis (MS) is a chronic neurological disease that affects the central nervous system (the brain and spinal cord). MS can cause symptoms throughout the body depending on which nerves are affected. Weak limbs, tingling limbs, vision problems, lack of coordination, and fatigue are some of the symptoms that may occur with MS. MyMSTeam members also frequently discuss heart palpitations.
Heart palpitations in MS can be caused by anxiety, medication side effects, co-occurring hypertension, and MS itself. Palpitations are irregular heart rhythms or unusually rapid heartbeats. Palpitations can feel like skipped heartbeats or a feeling of fluttering, pounding, or flip-flopping in the chest. They are often not serious, but in some cases they may indicate a life-threatening condition.
If you are experiencing heart palpitations, tell your doctor about your symptoms. Your doctor will determine if you need an electrocardiogram (ECG or EKG) or other tests to check for serious health conditions. Palpitations could be a sign of heart attack, heart failure, or other serious health conditions if they occur along with the following symptoms:
“I have heart palpitations, and yes, it’s related to my MS. I feel it mostly at night, and it feels like my heart is flopping out of my chest,” one MyMSTeam member wrote.
“I’ve been having weird heart palpitations. Luckily they are benign, as tons of testing have shown. Doc says he thinks it is MS-related. Anyone else get chronic, nonstop heart palpitations when tired or stressed out?” wrote another member.
Anxiety is common with MS due to the challenges and uncertainties of living with the condition. Research indicates that approximately 42 percent of people living with MS may have significant anxiety. As many as two-thirds of people with MS and anxiety have not been officially diagnosed, and as many as half are not receiving treatment.
Palpitations can be a symptom of anxiety or panic attacks and are usually not serious. If you and your doctor believe your heart palpitations may be due to anxiety, it’s important to know that anxiety with MS can be treated. In a study of 20 participants with MS and anxiety, treatment with cognitive behavioral therapy resulted in significant improvement of anxiety symptoms and quality of life.
Medication is also sometimes used to treat anxiety. “My doctor put me on vitamin D and Zoloft because she thinks the palpitations are from stress. Hopefully it helps,” one MyMSTeam member said.
Some MS drug side effects increase the risk of heart palpitations. The drug fingolimod (Gilenya) has been associated with slowed heart rate, also known as bradycardia. The U.S. Food and Drug Administration (FDA) has advised that people with MS who have preexisting bradycardia or have had recent heart conditions or stroke should not take fingolimod.
Other MS medications known as disease-modifying treatments contain interferon. Interferon has been associated with cardiac arrhythmia — an irregular heartbeat — in some people. The drug glatiramer acetate (Copaxone) may increase the risk of fast or racing heartbeat, or tachycardia.
High doses of corticosteroids that are commonly used to treat MS flare-ups can also cause heart palpitations. They can cause atrial fibrillation or flutter (a type of irregular heartbeat), an increased heart rate, or a slowed heart rate.
One MyMSTeam member described their experience with steroids: “I developed high blood pressure due to pain and the high levels of steroids I took for optic nerve inflammation. My blood pressure levels dropped to near normal after I was weaned from the med. I have issues still with my heart rate, ranging from very high to very low.”
Before you start any medication for MS, your neurologist will review your medical history. Be sure to discuss any prior heart problems with your health care team.
People with MS have an increased risk of high blood pressure, also known as hypertension. High blood pressure is 25 percent more common in people with MS than the general population. Hypertension is considered a comorbidity of MS. A comorbidity is when two or more chronic medical conditions occur at the same time. Hypertension may cause irregular heartbeat (arrhythmia) in some people.
High blood pressure can be a serious condition. It can worsen MS if left untreated.
MS is known to affect the autonomic nervous system, which controls involuntary functions such as breathing and heart rate. People with MS may experience problems related to bladder function, sexual function, body temperature, or gastrointestinal function that are linked to inflammation in the autonomic nervous system. Heart palpitations and an irregular heartbeat can be caused by autonomic dysfunction.
Palpitations due to autonomic nervous system dysfunction — also called cardiac autonomic dysfunction (CAD) — can cause serious complications in people with MS. Although the exact cause of autonomic problems in MS is not fully understood, researchers believe they may be connected to MS lesions on the brain stem, spinal cord, or hippocampal region of the brain. CAD can be difficult to diagnose. It is sometimes determined based on other autonomic problems in people with MS.
Some MyMSTeam members have discussed autonomic palpitations and have questions about them. “The palpitations are scary when they are bad and take my breath away,” one member wrote. “I wrote an email to my PCP [primary care physician] and will be calling my neurologist tomorrow, as I read that a lesion on the brain stem could affect autonomic functions. I definitely want to rule out everything.”
Another member said, “I have palpitations when I wake up in the morning and difficulty swallowing, along with many other symptoms that fit dysautonomia. I am newly diagnosed with MS, so I wonder if dysautonomia is a part of it, or if it has another cause?”
Many people with MS experience a type of chest pain known as the MS hug. The MS hug can feel like palpitations, chest pain, or pressure in the chest due to muscle spasms in the rib cage. Because chest pain can be a serious symptom of heart disease or other health problems, be sure to talk to your doctor if you experience a tightening in your chest.
Although some heart palpitations may not be serious, others may require a referral to a cardiologist. It is important to discuss any palpitations you experience with your health care provider.
On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 183,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Do you have questions about heart palpitations and MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.