You’re going about your day when all of a sudden, your heart starts beating so fast it feels like it’s going to burst out of your chest. You may even start to lose your breath or break out in a sweat. Does this sound familiar to you?

These racing heartbeats are known as heart palpitations, and they’re a common side effect of many medications. MyLupusTeam members have asked others if their lupus medications — like methotrexate (Rheumatrex) — can cause this symptom.

“Does methotrexate cause heart palpitations and severe weakness? I just started methotrexate two weeks ago, and I’m also on hydroxychloroquine and prednisone. I woke up feeling bad, then when I was sweeping, I got extremely hot, broke out in a sweat, and started having heart palpitations,” said one concerned MyLupusTeam member.

In this article, we’ll cover what heart palpitations are, why methotrexate might cause them, and what other conditions are associated with them. We’ll also discuss when you should talk to your doctor or seek medical attention if you’re having palpitations.

What Are Heart Palpitations?

You’ve probably used the phrase “My heart skipped a beat” when you were surprised or scared about something. This is the perfect explanation for heart palpitations, which feel like your heart is pounding irregularly or racing too quickly. Others report that their palpitations feel like a fluttering or flip-flopping sensation.

Heart palpitations usually come and go quickly and last only a few seconds to a few minutes. You may feel them in your chest, throat, or neck. There are several reasons why you might have heart palpitations, including:

• Medications that affect your blood pressure, thyroid (an organ that controls hormone balance), or heart rhythm
• Anxiety, panic, or fear
• Dehydration
• Fever (above 100.4 F)
• Pregnancy
• Exercise
• Alcohol or beverages with caffeine
• Nicotine
• Anemia or low red blood cell count

Can Methotrexate Cause Heart Palpitations?

Methotrexate is a disease-modifying antirheumatic drug (DMARD) that helps stop your immune system from attacking your body’s healthy cells and tissues. It’s used to treat lupus with joint pain and swelling, similar to rheumatoid arthritis.

According to Mayo Clinic, a common side effect of methotrexate is an increased heartbeat. This means if you take methotrexate, there’s a chance you’ll have heart palpitations. Other side effects you may experience include:

• Headache
• Mouth sores or ulcers
• Nausea and loss of appetite
• Stomach pain
• Diarrhea
• Hair loss
• Fatigue or feeling extremely tired

Your doctor or rheumatologist may prescribe you folic acid supplements to help prevent these side effects. Folic acid is a type of vitamin B that your cells need to make new DNA, proteins, and healthy red blood cells.

Methotrexate may also cause inflammation in your lungs, leading to scar tissue buildup. This condition is known as fibrosis and may lead to shortness of breath, coughing, and other lung problems. If you recently started taking methotrexate and you’ve noticed your heart racing or fluttering more often, talk to your doctor or rheumatologist.

Other Causes of Heart Palpitations When Living With Lupus

Lupus is an autoimmune disease, meaning that your immune system creates extra inflammation and attacks your body’s healthy cells and tissues. Systemic lupus erythematosus (SLE) — the most common type of lupus — involves many organs, including your skin, blood cells, kidneys, and joints.

The body-wide inflammation from lupus can also damage your heart and blood vessels, leading to complications. In fact, around half of people living with lupus have cardiovascular disease or heart disease.

If there’s a problem with your heart’s valves, the flaps of tissue that control blood flow, it can lead to an irregular heartbeat and palpitations. The same is true for myocarditis, which is when the heart muscle becomes inflamed. Both conditions can lead to these symptoms.

MyLupusTeam members have also reported that they have experienced heart palpitations during a flare. One member wrote, “Does anyone get palpitations during your flare? I’ve been getting lots of palpitations and skipped beats this past year. Just finished several cardiac tests, and my heart rhythm is normal. My cardiologist thinks it’s from lupus, so I was wondering if anyone here has this issue.”

Others replied with similar experiences:

• “I do get them during my flares, and they’re alarming! Deep breathing and changing my position helps.”
• “I experience fluttering, and it feels like skipped beats. When this happens, I feel weak and more fatigued.”

What Should You Do if You’re Having Heart Palpitations?

At the time, heart palpitations can be concerning — especially if you normally don’t have them. Fortunately, most cases are harmless, and your racing heart should calm down after a few minutes.

If you think your methotrexate prescription or other lupus medications may be causing heart palpitations, talk to your doctor or rheumatologist. They can adjust your dose or give you advice on how to manage them.

Continue taking your lupus medications to help manage your symptoms and prevent flares. If your heart palpitations tend to start when your lupus symptoms are worse, it’s best to stick to your treatment plan as closely as possible. Common treatments that can help you manage lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Motrin, Advil) or naproxen (Aleve)
• Corticosteroids, like prednisone
• Biologics, like belimumab (Benlysta)

Anxiety and stress can also raise your heart rate. One member shared, “I also have heart palpitations. I was diagnosed with severe anxiety attacks. My therapist taught me a technique to ground myself when I feel the palpitations coming on.”

If your heart starts racing or beating irregularly when you become panicked, anxious, or worried, your doctor or a mental health professional can help. They’ll teach you new ways to manage your emotions and prevent palpitations before they start.

When Are Heart Palpitations a Concern?

There are some times when palpitations are something to worry about. They may be a sign of a more serious health issue or a heart attack. You should seek medical attention immediately if you:

• Suddenly feel like you can’t catch your breath
• Pass out after having palpitations
• Have pain, tightness, or pressure in your chest, jaw, neck, or shoulders

One MyLupusTeam member shared what they do when they’ve had palpitations and other symptoms in the past: “I wound up in the emergency room (ER) several times with chest pain, palpitations, and sweating, which are all classic heart attack symptoms. It’s way better to go to the ER and be told, ‘Your heart is fine, it’s just a symptom of XYZ’ and know that for the future than not go and worry or actually have a serious problem.”

Let your doctor and rheumatologist know if you visit the ER and get treated for heart palpitations. They can help you get to the bottom of your symptoms and change your treatment plan as needed.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Have you had heart palpitations while taking methotrexate or living with lupus? Share your experience in the comments below, or start a conversation by posting on your Activities page.