Can Vaping Cause Heart Palpitations?

Since the appearance of e-cigarettes on the market 18 years ago, the number of users has quickly grown. The trend, first seen as a healthier substitution for classical cigarettes, spread in recent years mostly among young people and was branded as vaping. In this article, we will take a close look at the potential impact of vaping on heart health. We will discuss how substances found in e-cigarettes can affect heart rate and potentially lead to heart palpitations.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can vaping cause heart palpitations?

Yes, there is an indication that vaping can cause heart palpitations. With the progression of research, electronic cigarettes have been associated with several cardiovascular effects. Because of the recent appearance of vaping products (2007) on the market, mostly only the short-term effects have been studied. They showed that the use of nicotine-containing liquids raises the heart rate for around three quarters of an hour. Additionally, arterial pressure increases too [1, 2, 3]. Moreover, it was found that e-cigarettes can potentially induce both ventricular and atrial arrhythmias, which are then perceived as heart palpitations [4].

What is vaping?

Vaping is the act of inhaling and exhaling an aerosol. This so-called vapor is produced by an e-cigarette or a vape pen. To attract some users, these battery-powered devices often mimic the shape of traditional cigarettes, and the aerosol is created by heating up a liquid or wax. The commonly found substances are nicotine, cannabinoids, flavorings, and additives like glycerol or propylene glycol [5, 6].

What are the substances found in the aerosol?

A multicomponent analysis of e-liquids showed that the main constituents are propylene glycol, glycerol, and nicotine [7]. Other compounds found in e-liquids and aerosols include acenaphthylene, acetaldehyde, acetol, antimony, benzaldehyde, benzene, chromium, copper, diacetyl, formaldehyde, lead, limonene, naphthalene, nickel, nicotine-N'-oxides, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N-Nitrosonornicotine (NNN), toluene, and vegetable glycerin [8]. This long list of substances is astonishing.

Many of these substances are labelled toxic, harmful and cancerous [8]. With mostly younger generations enjoying vaping, it becomes a future problem as many of the health problems will occur in many years. One of the most commonly found substances in the liquids, propylene glycol and vegetable glycerin, were recognised by the FDA as safe. However, later research shows that they are toxic and able to damage blood vessels [9].

Moreover, the flavoring chemicals in e-liquids can also pose health risks. Some potentially harmful flavoring chemicals found in vape fluids include acrolein, acrylamide, acrylonitrile, benzaldehyde, citral, crotonaldehyde, ethylvanillin, eucalyptol, formaldehyde, propylene oxide, pulegone, and vanillin [10, 11].

The harmful potential of the substances found in the vapour is not constant in all products. It depends on the emission profile which is influenced by the ratio of glycerol to propylene glycol. For instance, acetaldehyde and acrolein toxicities increased by 175-fold and 28-fold, respectively, when the glycerol composition was increased from 0 to 80% [12].

Can vaping cause cardiac effects?

In medical studies, vaping was associated with several negative health and cardiac effects. They include cardiovascular homeostasis, inflammation, and molecular changes. All of them can potentially contribute to pathological health outcomes [13].

Nicotine, a key component of e-cigarettes, can potentially induce both ventricular and atrial irregular heart rhythms. Nicotine interacts with the catecholamines released by heart cells via potassium channels.

Nicotine can also cause structural alterations leading to atrial fibrillation. This occurs because nicotine downregulates microRNAs, which are responsible for repression of growth receptors [4]. In addition to nicotine, the flavorings in e-cigarettes can possibly lead to similar arrhythmic events. This happens when users are exposed to acrolein, an aldehyde. These substances stimulate and cause a shift towards sympathetic activation and autonomic imbalance [4].

Furthermore, chronic exposure to e-cigarette aerosols has been shown to cause many changes in the cardiovascular system. It was linked to increased arterial stiffness, vascular endothelial changes, increased angiogenesis, cardiorenal fibrosis, and increased atherosclerotic plaque formation [14].

In an experimental model on mice, e-cigarette vaping was found to significantly increase angiogenesis in heart tissue. Exposure to e-cigarette exposure increased the endothelial cell markers CD31 and CD34 approximately 2-fold [15]. (These markers are signs of active angiogenesis.)

Can quitting vaping cause heart palpitations?

Yes, quitting vaping can indeed potentially cause heart palpitations. This is primarily due to the withdrawal from nicotine. The main addictive substance in the vapor, which increases blood pressure and heart rate. In cases where the stimulant is missing, the body abruptly adjusts to the new reality. During the transition time, e.g. faster heart rhythm can be felt as heart palpitations [16, 17].

Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.