Why Does My Heart Race When I Drink Too Much?

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I feel my heart beating faster when I drink. Is this normal?

To a certain extent, yes, but there are some warning signs that indicate you should get these heart palpitations checked out.

There are a number of heart-rhythm problems that alcohol can trigger. Some are just nuisances while others, like atrial fibrillation, are real concerns, says Harmony Reynolds, M.D., a cardiologist and the associate director of the Cardiovascular Clinical Research Center at NYU Langone Medical Center in New York City. “This is one that I think may not be so easy to write off,” she says.

“Some people will feel the heart beating strongly when they’re drinking because they’re a little dehydrated and they may have an adrenaline response because of what else may be going on or just because of the alcohol,” Dr. Reynolds says. “That can be a normal heart rhythm or an abnormal heart rhythm, and there’s no real easy way to tell when it’s happening to you.”

Why does the heart react this way in the first place? Alcohol makes blood vessels in the skin get larger, a.k.a. dilate, which means the heart has to pump more blood to keep the same amount circulating through the rest of the body. It does this by beating a little harder and sometimes a little faster in order to keep up, she says. (This is known as a vasodilator effect and it can be stronger in Asian people, which is why many Asian people get flushed when they drink, Dr. Reynolds says.)

Some people notice the effect after a drink or two while others only feel their heart racing if they overdo it with, say, five drinks. Circumstantial factors — like stress, sleep deprivation, and caffeine — can make everything worse, because they all seem to evoke an adrenaline-type response, she says, as does alcohol.

“You could be at a bar, relaxed and having fun and you can be at a bar in a stressful situation,” Dr. Reynolds says. “There are a lot of different things — not just the amount of alcohol — that would explain why a palpitation happens one time and not another.”

So when should you call a doctor? Dr. Reynolds says that, overall, “if people are feeling their heart racing when they’re drinking, they should get it checked out.” But specific danger signs include palpitations lasting longer than a minute or two, feeling lightheaded, feeling short of breath, having chest pain or discomfort, sweating, and passing out or feeling like you’re going to.

Atrial fibrillation, or afib, is one abnormal heart rhythm that can be triggered by alcohol and cardiologists worry about this one because it comes with a risk of stroke, which is higher in women and in people with other risk factors that a doctor can assess, she says. Most people are going to be reassured, but, uh, much better to be safe here.

And for some people whose heart palpitations are caused by something more benign than afib, alcohol just isn’t worth it. “I have patients who have chosen to avoid alcohol completely because the good feelings are outweighed by the bad heart feelings. Even though their heart problem is not particularly dangerous, it’s just not that fun.”

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