Heart Palpitations
Feeling your heartbeat racing, pounding, or skipping
Quick Facts
- Type: Cardiovascular sensation / symptom
- Common triggers: Stress, caffeine, exercise, hormones
- Often: Harmless and brief
- Seek urgent care: Palpitations with chest pain, fainting, or breathlessness
Overview
Heart palpitations are the uncomfortable awareness of your own heartbeat. People describe them as a racing, pounding, fluttering, flip-flopping, or skipping sensation felt in the chest, throat, or neck. They can last seconds or minutes and may happen at rest or during activity.
Most palpitations are harmless and related to everyday triggers such as stress, exercise, caffeine, or strong emotions. Occasionally they are a sign of an abnormal heart rhythm (arrhythmia) or another medical condition such as a thyroid problem or anemia. Knowing which features point to a more serious cause helps decide when palpitations need medical attention.
Symptoms
Palpitations themselves are the main symptom, and people experience them in different ways.
- A racing or unusually fast heartbeat
- A pounding or forceful heartbeat
- A fluttering feeling in the chest
- A sensation that the heart skipped or added a beat
- Awareness of the heartbeat in the neck or throat
Palpitations are more concerning when they come with chest pain, shortness of breath, dizziness, fainting, or a feeling of impending collapse. These accompanying symptoms warrant prompt evaluation.
Causes
Palpitations have a wide range of causes, most of which are not dangerous.
- Lifestyle and emotional triggers: Stress, anxiety, panic, vigorous exercise, caffeine, nicotine, alcohol, and some recreational drugs.
- Hormonal changes: Pregnancy, menstruation, and menopause.
- Medical conditions: Overactive thyroid, anemia, low blood sugar, fever, and dehydration.
- Heart rhythm problems: Extra beats, atrial fibrillation, and other arrhythmias.
- Medications: Some asthma inhalers, decongestants, and other drugs.
Risk Factors
- High stress or an anxiety disorder
- Heavy caffeine, alcohol, or nicotine use
- Thyroid disease or anemia
- Existing heart disease or a previous arrhythmia
- Pregnancy and hormonal transitions
- Use of stimulant medications or certain over-the-counter products
Diagnosis
Evaluation focuses on whether the heart rhythm is normal and on finding any underlying cause.
- History and examination: Describing when palpitations occur, how long they last, and any triggers or associated symptoms.
- Electrocardiogram (ECG): Records the heart's rhythm, though it may be normal between episodes.
- Ambulatory monitoring: A Holter or event monitor worn for days to capture palpitations as they happen.
- Blood tests: To check thyroid function, blood count, and electrolytes.
- Further heart tests: An echocardiogram or specialist studies if an arrhythmia is suspected.
Treatment
Treatment depends entirely on the cause.
- Reassurance and trigger avoidance: Many harmless palpitations need no treatment beyond cutting back on caffeine, alcohol, or nicotine and managing stress.
- Treating underlying conditions: Correcting an overactive thyroid, anemia, or other medical problems often resolves the palpitations.
- Managing arrhythmias: If an abnormal rhythm is found, medications, procedures such as catheter ablation, or other heart treatments may be recommended.
- Reviewing medications: Adjusting drugs that trigger palpitations where possible.
Prevention
- Limit caffeine, alcohol, and nicotine
- Practice stress-reduction techniques such as slow breathing
- Stay well hydrated and avoid skipping meals
- Get enough sleep
- Keep thyroid and other conditions well managed
- Check with a pharmacist before using stimulant-containing products
When to See a Doctor
See a clinician if palpitations are frequent, lasting longer, getting worse, or if you have known heart disease. Call emergency services or seek emergency care if palpitations come with:
- Chest pain or pressure
- Severe shortness of breath
- Fainting or near-fainting
- Severe dizziness or a feeling of collapse
These can be signs of a serious heart rhythm problem and need immediate attention.
Frequently Asked Questions
Are heart palpitations dangerous?
Most palpitations are harmless and linked to stress, caffeine, exercise, or hormones. They become more concerning when they are frequent, prolonged, or come with chest pain, fainting, or severe breathlessness, which can signal a heart rhythm problem and need prompt care.
What commonly triggers palpitations?
Common triggers include stress and anxiety, caffeine, nicotine, alcohol, vigorous exercise, fever, dehydration, low blood sugar, and hormonal changes such as during pregnancy or menopause. An overactive thyroid and anemia can also cause them.
When should I go to the emergency room for palpitations?
Seek emergency care if palpitations occur with chest pain, severe shortness of breath, fainting or near-fainting, or severe dizziness. These can be signs of a dangerous arrhythmia or another serious heart condition.
Why do I get palpitations at night or when lying down?
Lying down can make you more aware of your heartbeat, and positions that press on the chest or stomach may make beats feel stronger. Caffeine, alcohol, stress, and indigestion before bed can also contribute. Frequent nighttime palpitations are worth discussing with a clinician.
How are palpitations diagnosed if they come and go?
Because palpitations are often gone by the time you see a doctor, a portable heart monitor worn for days or weeks (a Holter or event monitor) is used to record the rhythm during an episode. Blood tests check for thyroid problems and anemia.
References
- Mayo Clinic. Heart palpitations — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Heart palpitations.
- National Heart, Lung, and Blood Institute (NHLBI). Arrhythmia.
- American Heart Association. Arrhythmia and palpitations.