Multiple sclerosis (MS) is a chronic disease that affects the central nervous system. MS can cause symptoms throughout the body depending on which nerves are affected. While vision problems, numbness, lack of coordination, and fatigue are some common MS symptoms, MyMSTeam members also talk about having heart palpitations.

Palpitations may be an MS heart symptom. On the other hand, palpitations can also be caused by anxiety, medication side effects, heart abnormalities, or co-occurring high blood pressure. Usually, palpitations aren’t serious. But in some cases, they can be a sign of a life-threatening issue.

What Do Heart Palpitations Feel Like?

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.

If you are experiencing heart palpitations, tell your doctor about your symptoms. They’ll decide whether to recommend an electrocardiogram (ECG or EKG), blood test, or other tests to check for serious health conditions.

Palpitations could be a sign of a heart attack, heart failure, or other serious health conditions, especially if they happen with the following symptoms:

• Pain or pressure in the chest
• Dizziness, fainting, confusion, or lightheadedness
• Trouble breathing or shortness of breath

“I have heart palpitations, and yes, I believe 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 has shown. Doc says he thinks it may be MS related. Anyone else get chronic, nonstop heart palpitations when tired or stressed out?” wrote another member.

Does MS Cause Heart Palpitations?

MS affects the autonomic nervous system. This system regulates the involuntary functions that happen without your conscious control. For example, people with MS may experience problems related to bladder function, sexual function, body temperature, or their digestive systems. Heart palpitations and an irregular heartbeat can also be caused by autonomic dysfunction.

Cardiac Autonomic Dysfunction

Palpitations from autonomic nervous system dysfunction can be part of a condition called cardiac autonomic dysfunction (CAD). CAD can cause serious complications in people with MS. Researchers aren’t exactly sure what causes CAD. They suspect it may be related to MS lesions on the brain stem, spinal cord, or hippocampal region of the brain. CAD can be difficult to diagnose. Healthcare providers may look at a combination of autonomic problems in people with MS to determine if they have CAD.

MyMSTeam members have discussed and wondered about autonomic palpitations. “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?”

The MS Hug and Palpitations

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.

Heart Palpitations and Anxiety

Anxiety is common with MS due to the challenges and uncertainties of living with the condition. In one study, 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. If you and your doctor believe your heart palpitations are from anxiety, it’s important to know that treatment can help. Different forms of psychotherapy and meditation are useful tools to treat anxiety.

Medication is also sometimes used to treat anxiety. “My doctor put me on vitamin D and an antidepressant because she thinks the palpitations are from stress. Hopefully it helps,” one MyMSTeam member said. Various antidepressant and antianxiety medications are available to help keep anxiety under control.

Heart Palpitations and MS Medication Side Effects

Some disease-modifying therapies (DMTs) taken to slow MS progression and reduce relapses can cause side effects that increase the risk of heart palpitations. The DMT fingolimod (Gilenya) has been associated with slowed heart rate, also known as bradycardia. This effect usually happens within six hours of the first dose and may peak 20 hours after taking it. The U.S. Food and Drug Administration (FDA) has advised that people with MS and certain cardiovascular risk factors should not take fingolimod.

Other DMTs contain forms of a drug called interferon. A fast or slow heart rate is a less common side effect of interferons. The DMT glatiramer acetate (Copaxone) may increase the risk of tachycardia (a fast or racing heartbeat).

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 a DMT, your neurologist will review your medical history. Be sure to discuss any heart problems that you have or that run in your family.

Hypertension, Palpitations, and MS

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 in the general population. Hypertension is considered a comorbidity of MS. A comorbidity is when you have two or more chronic medical conditions at the same time. Hypertension may cause arrhythmia (irregular heartbeat) in some people.

High blood pressure is a serious condition that doesn’t always cause noticeable symptoms. If left untreated, high blood pressure raises your risk of strokes and heart attacks. Some people can manage high blood pressure with healthy lifestyle changes. Others need medication to keep it under control.

Manage Palpitations With Your Doctor

Heart palpitations may not be serious. But in certain cases, they warrant a referral to a cardiologist or immediate medical attention at the hospital.

Talk to your healthcare provider about any heart health concerns you have, including palpitations. Heart palpitations may require ongoing follow-up and treatment. Medications like calcium channel blockers or beta-blockers can help with certain heart conditions. Your healthcare provider can recommend tests to figure out what’s causing your symptoms and determine your best course of action.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you experienced heart palpitations? What are your questions or concerns about cardiovascular disease and MS? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.