Heart Palpitations

Overview

Heart palpitations are the uncomfortable awareness of your own heartbeat. People describe them as the heart racing, pounding, fluttering, flip-flopping, or skipping a beat. They may last a few seconds or longer and can be felt in the chest, throat, or neck. Most palpitations are brief and harmless, often triggered by stress, caffeine, exercise, or hormonal changes.

Sometimes, however, palpitations are caused by an irregular heart rhythm (arrhythmia) or another heart or medical condition that needs attention. The key is the company they keep: palpitations on their own in an otherwise healthy person are usually benign, while palpitations with chest pain, fainting, severe breathlessness, or dizziness can be more serious. Noting what brings them on and what else you feel helps guide the right response.

If you can, note when palpitations occur, how long they last, what they feel like, and what else you notice at the time, such as dizziness or chest discomfort. Many smartwatches and phone apps can record a basic heart trace during an episode, which a clinician may find helpful in pinpointing the cause.

Common Causes

Palpitations have many possible causes, most of them harmless:

• Stress and anxiety: Strong emotions and anxiety commonly cause a pounding or racing heartbeat.
• Stimulants: Caffeine, nicotine, energy drinks, and some cold or asthma medicines.
• Exercise and exertion: A normal, faster heartbeat felt more strongly.
• Hormonal changes: Pregnancy, menstruation, and menopause.
• Irregular heart rhythms: Conditions such as atrial fibrillation or other forms of arrhythmia.
• Medical conditions: Overactive thyroid, fever, anemia, low blood sugar, or dehydration.
• Alcohol and some recreational drugs.

Associated Symptoms

The symptoms that occur with palpitations are crucial for judging how serious they are:

• A clearly fast, slow, or irregular pulse
• Lightheadedness or dizziness
• Shortness of breath
• Chest pain, pressure, or tightness
• Sweating or anxiety
• Fainting or near-fainting

Palpitations accompanied by chest pain, fainting, severe shortness of breath, or a sense of impending collapse are warning signs and require emergency care. Palpitations alone, lasting seconds and settling on their own, are usually not dangerous.

It also helps to notice whether the heartbeat feels regular or irregular during an episode, and whether the palpitations start and stop abruptly or build up gradually. A sustained, fast, irregular beat is more likely to reflect an arrhythmia, while brief skipped beats in an otherwise well person are usually harmless extra beats.

Diagnosis & Evaluation

A clinician will ask what the palpitations feel like, how long they last, what triggers them, and what other symptoms occur. Evaluation may include:

• A physical exam and check of the pulse and heart sounds
• Electrocardiogram (ECG): A recording of the heart's electrical activity, best captured during symptoms.
• Holter or event monitor: A wearable device that records the heart rhythm over hours to days to catch intermittent palpitations.
• Blood tests for thyroid problems, anemia, and electrolyte levels.
• An echocardiogram or other tests if a structural heart problem is suspected.

Treatment & Management

Treatment depends on the cause. Many people need only reassurance and a few changes:

• Reducing triggers: Cutting back on caffeine, nicotine, alcohol, and stimulant medicines.
• Stress management: Relaxation techniques, good sleep, and addressing anxiety.
• Treating underlying conditions: Managing thyroid problems, anemia, fever, or dehydration.
• Medication: When an arrhythmia is confirmed, medicines may be used to control the heart rate or rhythm.
• Procedures: Some rhythm disorders are treated with a procedure such as catheter ablation.
• Vagal maneuvers: For certain fast rhythms, specific techniques taught by a clinician may help stop an episode.

For many people, simply learning that their palpitations are harmless extra beats brings considerable relief, since anxiety about the sensation can itself make it feel worse. When a specific rhythm disorder is identified, however, following the treatment plan and attending follow-up appointments is important to keep the heart rhythm well controlled over the long term.

When to See a Doctor

See a doctor if palpitations are frequent, getting worse, last a long time, or come with a known heart condition. Call emergency services immediately if palpitations occur with any of these warning signs:

• Chest pain, pressure, or tightness
• Severe shortness of breath
• Fainting or near-fainting
• Severe dizziness or a feeling of collapse

These can indicate a serious heart problem. When in doubt, especially if symptoms are severe or sudden, seek emergency care rather than waiting.

Related Topics

Frequently Asked Questions

References

1. American Heart Association. Arrhythmia and palpitations.
2. Mayo Clinic. Heart palpitations — Symptoms and causes.
3. National Heart, Lung, and Blood Institute (NHLBI). Arrhythmias.
4. MedlinePlus, U.S. National Library of Medicine. Heart palpitations.