Multiple sclerosis primarily affects the central nervous system. In some people it may also disrupt autonomic control of heart rate and blood pressure, while certain MS medicines can have cardiovascular effects. Palpitations still need to be evaluated on their own merits.
Multiple sclerosis (MS) is not generally considered a direct cause of heart palpitations in the way that an arrhythmia is. However, MS can affect the autonomic nervous system, which helps regulate heart rate and blood pressure. In some patients, cardiovascular autonomic dysfunction may contribute to a fast heartbeat, dizziness or palpitations, especially with changes in posture. Certain MS medicines can also affect heart rate. Because palpitations have many other causes, new or recurrent symptoms should not automatically be attributed to MS.
What Is Multiple Sclerosis?
Multiple sclerosis is a chronic immune-mediated neurological disorder affecting the central nervous system, particularly the brain and spinal cord.
In MS, the immune system attacks myelin, the protective material surrounding nerve fibers, and other parts of nervous tissue. The resulting inflammation and damage can interfere with communication between the brain, spinal cord and the rest of the body.
Symptoms differ greatly between individuals and depend partly on which nervous-system pathways are affected.
Common manifestations can include:
- vision problems;
- numbness or tingling;
- muscle weakness;
- stiffness or muscle spasms;
- balance and coordination problems;
- dizziness;
- fatigue;
- bladder dysfunction; and
- cognitive changes.
MS can also affect autonomic functions such as bladder, bowel, sweating and cardiovascular regulation in some patients.
Can Multiple Sclerosis Cause Heart Palpitations?
There is evidence of an association between MS and abnormalities of cardiovascular autonomic regulation. However, this does not mean that MS routinely causes arrhythmias or that every palpitation in a person with MS is neurologic in origin.
A palpitation is simply the sensation of being unusually aware of the heartbeat. It may feel like racing, pounding, fluttering, skipping or an extra beat.
The sensation may occur during a normal rhythm, during sinus tachycardia, with premature beats, or with a genuine arrhythmia.
Having MS does not establish the cause of a palpitation. The rhythm itself may still need to be recorded with an ECG, Holter, patch or event monitor before anyone can say whether the symptoms represent an arrhythmia.
For more information about the sensations themselves, see our guide to heart palpitation symptoms.
How Could MS Affect Heart Rate and Blood Pressure?
The autonomic nervous system regulates functions that normally occur automatically, including heart rate, blood pressure, sweating and gastrointestinal activity.
Because MS lesions can involve central nervous-system pathways that participate in autonomic regulation, some people with MS develop cardiovascular autonomic dysfunction.
Research has reported several possible abnormalities, including:
Changes in heart-rate variability
Studies have found altered heart-rate variability in some people with MS, suggesting changes in sympathetic and parasympathetic cardiovascular regulation.
Orthostatic intolerance
Some people with MS report dizziness, weakness or other symptoms after standing because heart rate and blood pressure responses to posture may be abnormal.
Orthostatic hypotension
In selected patients, blood pressure can fall abnormally when standing. This may cause lightheadedness, blurred vision, weakness or near-fainting.
Postural tachycardia
Postural orthostatic tachycardia syndrome (POTS) has been reported in association with MS, although it should not be assumed merely because someone with MS develops a fast heartbeat on standing.
Studies of autonomic dysfunction in MS vary substantially in their methods and findings. For that reason, there is no reliable percentage showing that a particular proportion of all people with MS will develop heart palpitations.
Important Medical Correction
Multiple sclerosis should not be confused with systemic sclerosis (scleroderma).
Systemic sclerosis is a different autoimmune disease in which vascular abnormalities and tissue fibrosis can directly involve the heart, lungs, skin and other organs.
Multiple sclerosis is primarily a neurological disease. Myocardial fibrosis, coronary microvascular vasospasm, pulmonary hypertension and pericardial disease should therefore not be presented as routine mechanisms explaining palpitations in MS.
Do Not Assume Every Palpitation Is Caused by MS
Someone with multiple sclerosis can develop the same common palpitation triggers and cardiovascular conditions as anyone else.
Other possibilities include:
- stress or anxiety;
- caffeine or energy drinks;
- nicotine;
- dehydration;
- fever or infection;
- iron-deficiency anemia or other significant anemia;
- thyroid disease;
- electrolyte abnormalities;
- medication effects;
- premature atrial contractions (PACs);
- premature ventricular contractions (PVCs);
- supraventricular tachycardia;
- atrial fibrillation; and
- other cardiovascular conditions.
Our comprehensive causes of heart palpitations guide discusses these possibilities in more detail.
Can Multiple Sclerosis Medicines Affect Heart Rate?
Yes. The cardiovascular effects vary considerably between MS disease-modifying therapies, so the particular medicine matters.
Fingolimod
Fingolimod can cause a temporary reduction in heart rate and atrioventricular (AV) conduction abnormalities when treatment is started.
For this reason, current prescribing information requires first-dose monitoring, including pulse and blood-pressure checks and ECG assessment. Patients requiring additional monitoring are observed longer according to their findings and cardiovascular risk.
A patient taking fingolimod who develops dizziness, fainting, unusual weakness or a markedly slow or abnormal heartbeat should report these symptoms to the treating team.
Siponimod (Mayzent)
Siponimod can also cause a temporary decrease in heart rate and AV conduction delays during treatment initiation.
Treatment therefore begins with dose titration, and selected patients with cardiovascular conditions or medicines that affect heart rate require additional evaluation or monitoring.
Glatiramer Acetate
Glatiramer acetate can occasionally produce an immediate post-injection reaction. Symptoms may include flushing, chest discomfort, palpitations, tachycardia, anxiety and shortness of breath.
Some of these symptoms can overlap with anaphylaxis. Severe breathing difficulty, throat swelling, widespread hives, collapse or other signs of a severe allergic reaction require emergency medical care.
Contact your neurologist or prescribing clinician. Depending on the drug, stopping and restarting treatment can itself have important clinical implications. The safest approach is medication review combined with appropriate assessment of the heart rhythm.
How Are Palpitations Evaluated in Someone With MS?
The basic cardiac evaluation is similar to the evaluation of palpitations in someone without MS. The clinician then considers MS-related autonomic symptoms and medication effects in addition to the usual causes.
Medical history
Your doctor may ask:
- when the palpitations started;
- how long they last;
- whether they begin suddenly or gradually;
- whether the heartbeat feels regular or irregular;
- whether symptoms occur after standing;
- whether dizziness or near-fainting accompanies them;
- whether they happen around an MS medication dose or injection;
- which disease-modifying therapy and other medicines you take;
- whether caffeine, nicotine or stimulants are involved;
- whether there is chest pain or breathlessness; and
- whether you have a personal or family history of heart disease.
Blood pressure and pulse
If symptoms occur with standing, the clinician may compare heart rate and blood pressure while lying, sitting and standing.
In selected patients with prominent orthostatic symptoms, more formal autonomic or tilt-table testing may be appropriate.
12-lead ECG
An electrocardiogram can identify the heart rhythm and detect certain conduction abnormalities or other cardiac findings.
A normal ECG between episodes does not completely rule out an intermittent arrhythmia.
Holter, patch or event monitor
If symptoms come and go, ambulatory ECG monitoring can record the heart over a longer period.
The goal is to establish a symptom-rhythm correlation: determining whether the sensation occurred during normal rhythm, sinus tachycardia, premature beats or another arrhythmia.
Blood tests
Depending on the clinical situation, your doctor may consider testing for anemia, thyroid dysfunction or significant electrolyte abnormalities rather than assuming that MS explains the symptoms.
Additional testing
Echocardiography or other cardiac testing is not automatically necessary simply because a person has MS. It may be appropriate when the examination, ECG, documented rhythm, symptoms or medical history raise concern about structural cardiovascular disease.
Dr. Albana’s Note
When a patient with multiple sclerosis tells me about palpitations, I keep autonomic dysfunction and medication effects in mind, but I do not automatically label the symptom as part of MS. I first ask whether the heartbeat changes with standing, whether dizziness or faintness occurs, which MS medicines the patient is taking, and whether the rhythm feels fast, irregular or simply more noticeable. An ECG or ambulatory monitor can often answer the most important question: what rhythm is actually happening when the symptom occurs?
When Should You Contact a Doctor?
Arrange medical assessment if palpitations:
- keep returning or are becoming more frequent;
- last longer than brief isolated beats;
- are persistently fast or markedly irregular;
- regularly occur when you stand up;
- are associated with recurring dizziness or near-fainting;
- started after beginning or changing an MS medicine;
- occur after an injection together with chest or breathing symptoms;
- occur during exercise;
- significantly reduce your usual activity; or
- occur in someone with known cardiovascular disease.
If dizziness accompanies your symptoms, see our guide to dizziness and heart palpitations.
If unusual weakness accompanies the episodes, see heart palpitations and weakness.
Urgent Warning Signs
Seek urgent or emergency medical care if palpitations occur with:
- chest pain or significant chest pressure;
- fainting or loss of consciousness;
- collapse;
- severe shortness of breath;
- severe dizziness or near-fainting;
- a sustained very rapid or markedly abnormal heartbeat while feeling seriously unwell;
- severe weakness or rapidly worsening symptoms; or
- signs of a serious allergic reaction after medication, such as throat swelling or severe breathing difficulty.
Do not assume that severe cardiovascular symptoms are simply part of multiple sclerosis. They require appropriate medical assessment.
Most Asked Questions
Can multiple sclerosis cause heart palpitations?
MS can affect autonomic nervous-system pathways involved in regulating heart rate and blood pressure, so autonomic dysfunction may contribute to palpitations in some patients. However, palpitations have many other causes and should not automatically be attributed to MS.
Are heart palpitations common in people with MS?
Palpitations and orthostatic symptoms have been reported in studies of cardiovascular autonomic dysfunction in MS, but study results vary widely and many studies are small. There is not a reliable percentage showing that palpitations are a common symptom in all people with MS.
Can MS affect heart rate?
It may in some patients. Cardiovascular autonomic dysfunction can alter regulation of heart rate and blood pressure. These abnormalities are not present in everyone with MS and require appropriate clinical evaluation.
Why does my heart race when I stand up?
A fast heartbeat with standing can occur for several reasons, including dehydration, medication effects and orthostatic disorders. Cardiovascular autonomic dysfunction has been reported in MS, including postural tachycardia in selected patients, but formal evaluation is needed before diagnosing POTS or another autonomic disorder.
Can fingolimod affect my heart?
Yes. Fingolimod can transiently reduce heart rate and affect AV conduction when treatment is initiated. Current prescribing information therefore requires first-dose cardiovascular monitoring.
Can glatiramer acetate cause palpitations?
Yes. An immediate post-injection reaction to glatiramer acetate can include palpitations, tachycardia, flushing, chest discomfort, anxiety and shortness of breath. Because some symptoms overlap with anaphylaxis, severe or unusual reactions require prompt medical evaluation.
Does MS cause heart failure or myocardial fibrosis?
These should not be presented as routine direct manifestations of multiple sclerosis. Older descriptions of myocardial microvascular ischemia and fibrosis may confuse multiple sclerosis with systemic sclerosis, which is a different autoimmune disease with recognized direct cardiac involvement.
Can a normal ECG rule out an arrhythmia?
Not always. A standard ECG records only a short period. If symptoms are intermittent, a Holter, patch or event monitor may be needed to record the rhythm during an actual episode.
Related Heart Palpitation Guides
Medical References
- National Institute of Neurological Disorders and Stroke. Multiple Sclerosis (MS). NINDS .
- Zahoor I, Pan G, Cerghet M, et al. Current Understanding of Cardiovascular Autonomic Dysfunction in Multiple Sclerosis. Heliyon. 2024;10(15):e35753. PubMed Central .
- Findling O, Hauer L, Pezawas T, et al. Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies. J Clin Med. 2020;9(2):335. PubMed Central .
- DailyMed. Fingolimod Capsules — Full Prescribing Information. U.S. National Library of Medicine .
- DailyMed. MAYZENT (siponimod) — Full Prescribing Information. U.S. National Library of Medicine .
- DailyMed. Glatiramer Acetate Injection — Prescribing Information. Includes warnings regarding immediate post-injection reactions, palpitations, tachycardia and chest symptoms. DailyMed .
- American Heart Association. Symptoms, Diagnosis and Monitoring of Arrhythmia. American Heart Association .
- American Heart Association. Common Tests for Arrhythmia. American Heart Association .
About the Medical Team
Dr. Albana Greca, MBBS, MMedSc
Family Physician / General Practitioner
Dr. Albana Greca has more than 20 years of experience in primary care, general medicine, chronic disease management, prevention, patient education and digital health.
Dr. Benard Shehu, MBBS, MS
Cardiologist
Dr. Benard Shehu has more than 19 years of cardiovascular experience, including clinical experience relevant to arrhythmias and cardiovascular disease.