January 21, 2026
Saying your heart "flip-flops" or "skips a beat" with love at first sight is kind of sweet. But if your heart literally flip-flops or beats irregularly — love or no love — it can be cause for concern.
"Our hearts beat all day, every day, and we are so used to the rhythm that we don’t necessarily feel it," says Andrea Kuensting, AHCNS, an MU Health Care advanced practice nurse specializing in cardiovascular medicine and electrophysiology. "Feeling your heart beating or racing (palpitations) can be a sign that your heartbeat is irregular. The tricky thing is that it can come and go, and not everyone recognizes the symptoms."
An irregular heartbeat (arrhythmia) is a sign of atrial fibrillation (AFib) — the most common heart rhythm disorder. Leaving AFib untreated can have severe consequences — it doubles your risk of death and makes you five times more likely to have a stroke. The problem is that one in three people with AFib don't know they have it.
Since knowledge is power — especially in this case — Kuensting shares 5 things you need to know about AFib:
1. Heart Palpitations Are Not the Only Symptom of AFib
Atrial fibrillation happens when irregular electrical signals in the upper part of your heart cause it to quiver (fibrillate). Your heartbeat begins in the upper part of the heart, so the quivering causes your heart to beat faster and pump blood at a different rate.
Palpitations are the most common symptom leading to an atrial fibrillation diagnosis. But it is not the only sign.
Other lesser-known symptoms of AFib include:
- Chest pain
- Dizziness
- Exercise intolerance
- Fatigue
- Frequent urination
- Shortness of breath
- Swelling in legs and feet
Many of these symptoms, such as shortness of breath and chest pain, bring people to the doctor. But the sneaky symptoms, according to Kuensting, are fatigue and exercise intolerance. She says many of her patients with AFib don't realize how tired they have been until their heart is beating normally again.
"When you gradually go into atrial fibrillation, you may not notice a big or sudden change in how you feel," Kuensting says. "But it can impact your level of exercise. Ask yourself if there are activities you were easily doing a year ago that give you trouble now. If there's no other explanation for your reduced exercise tolerance, you should talk to your doctor about it."
2. AFib Can Be Mistaken for Anxiety or Menopause
Many of the symptoms of AFib have alternative explanations. So, it's easy to assume they are caused by something else. Fatigue and more frequent urination could be signs your body is changing with age. Shortness of breath, dizziness and a racing heart could signal stress or a panic attack.
Kuensting says the most common alternative explanations for the symptoms of AFib tend to be:
- Anxiety
- Menopause
- Stress
If you can't tell whether your palpitations are anxiety, Kuensting recommends taking these steps:
- Lie down
- Take deep breaths
- Calm yourself
- See if your racing heart slows or goes away
- Seek help if you still feel palpitations
"To be defined as AFib, an EKG (electrocardiogram) or heart monitor needs to detect atrial fibrillation for more than 30 seconds," Kuensting says. "Until then, it's not considered AFib or associated with elevated stroke risk."
One way to monitor your heart health is to use a smart watch or other wearable technology. But if you've never been diagnosed with AFib and think you may be having palpitations, Kuensting advises that you go to urgent or emergency care.
"The nature of the disease is that it comes and goes," Kuensting says. "The most valuable tool in diagnosing AFib is getting an EKG while it is happening."
3. Stimulants, Stress and Sickness Can All Trigger AFib
AFib rarely occurs without underlying issues. Usually, it’s secondary to other factors — most often aging. The risk of AFib increases as you get older, with about 25% of people over age 60 affected. And as you age, you are more likely to develop heart disease and the chronic health issues that can cause AFib, such as:
- Diabetes
- High blood pressure
- Lung disease
- Obesity
- Obstructive sleep apnea
- Thyroid disease
But anything that increases your heart rate can trigger AFib. Kuensting says common triggers for atrial fibrillation include:
- Alcohol
- Dehydration
- Illness and infection
- Smoking or using tobacco
- Stimulants
- Stress
"Stimulants include caffeine, but energy drinks, cold medicine and some prescription medications also fall into that category," Kuensting says. "They can get your heart racing and throw your heartbeat out of rhythm."
4. Once You Have AFib, You Have It for Life
Atrial fibrillation is a progressive disease and a lifelong condition.
The stages of atrial fibrillation include:
- Paroxysmal: An irregular heartbeat comes and goes, only lasting seconds or a minute.
- Persistent: Your heart beats chaotically for days and weeks at a time.
- Long-standing persistent: In this final stage, your heartbeat is irregular for months or years and is more resistant to treatment.
"If you've been diagnosed with atrial fibrillation, the goal is to prevent it from progressing to the next stage," Kuensting says. "In addition to treatment, you should avoid common triggers, because they are often what moves the disease forward to the next stage."
In recent years, the incidence of AFib at younger ages is on the rise, especially in people with existing heart issues, such as high blood pressure. And people who develop AFib earlier tend to have a higher stroke risk.
However, there are some ways to reduce your risk for AFib or slow its progression:
- Make healthy lifestyle choices about your diet, exercise, alcohol use and smoking.
- Maintain a healthy weight to lower the risk of obesity, diabetes, sleep apnea and heart issues — which can all cause or worsen AFib
- Manage your blood pressure because 20% of atrial fibrillation cases are associated with high blood pressure
5. GLP-1 Drugs Can Help Treat AFib
Atrial fibrillation treatment is used to improve symptoms and prevent blood clots that can lead to stroke. Standard treatments include:
- Medication, to control the heart rate or thin the blood
- Cardioversion therapy, to reset the heart rhythm using electric shocks or drugs
- Cardiac ablation, which uses heat, cold or electrical current to create targeted cellular damage that blocks the abnormal electrical signals responsible for AFib
- Surgery, to create scar tissue that interferes with electrical signals
Newer treatments — often used alongside standard treatments — include:
- Pulsed field ablation, which preserves more healthy tissue by using electric pulses (instead of heat or cold therapy) to block abnormal electrical signals
- GLP-1 medication, which is helping patients with obesity lose weight to slow the progression of AFib
"The addition of these newer treatments is allowing us to be more successful in helping people with atrial fibrillation," Kuensting says. "But recognizing and treating atrial fibrillation early is still the best way to prevent its progression."
Next Steps and Useful Resources
- Curious about your heart health? Schedule a Love Your Heart Cardiac Screening.
- Want to discuss more with a doctor? Find a primary care provider.
