Heart Palpitations: Common Causes and When to Worry

Feeling your heart pound, flutter or skip a beat can be unsettling. Palpitations are very common and are usually harmless, but sometimes they signal a heart rhythm problem. This article explains what the NHS and other official sources say about causes, tests and when to get help.

What are palpitations?

The NHS describes palpitations as noticing your heartbeat more than usual. You may feel it in your chest, neck or throat. It can feel fast, pounding, fluttering or irregular, with skipped or extra beats. Episodes can last seconds, minutes or longer. The NHS says they are usually harmless.

NHLBI notes that a heart rate rises during exercise and falls at rest or during sleep, and that occasionally feeling a skipped beat is normal.

Common causes

Many everyday things can make you aware of your heartbeat. That does not mean something is wrong, and many people find the cause is simple, such as too little sleep or too much caffeine. A doctor can help work out whether your own palpitations are likely to have a harmless cause or need more checking.

According to the NHS, palpitations can be linked to:

• Strenuous exercise, poor sleep, stress or anxiety
• Some medicines (check the leaflet that comes with them)
• Alcohol, caffeine, nicotine or recreational drugs
• Menopause or pregnancy
• Conditions such as iron deficiency anaemia, an overactive thyroid, a heart rhythm problem or heart valve disease

Palpitations are also a symptom of some rhythm problems, such as atrial fibrillation and supraventricular tachycardia, which are covered in separate articles.

How are palpitations checked?

The NHS says an electrocardiogram (ECG), in which small pads on the skin record the heart's electrical signals, may be used, and you may be referred to a cardiologist for more tests. MedlinePlus explains that a Holter monitor is a portable device that records heart rhythm for 24 to 48 hours while you go about normal activities, and that it is used to find rhythm problems that cause palpitations or fainting. You keep a diary of symptoms so they can be matched with the recording.

Self-care and treatment

Before you see a doctor, it can help to keep a short diary. Note when palpitations happen, how long they last, what you were doing, and anything you had just eaten, drunk or taken. This is a general tip rather than medical advice, but it gives your doctor useful clues, and MedlinePlus notes that symptom diaries are matched with Holter recordings in just this way.

The NHS says that if palpitations are not caused by a health condition, avoiding triggers such as stress, smoking, caffeine and alcohol can help. Treatment depends on the cause, and palpitations often need no treatment. If a heart problem is the cause, medicines or a procedure may be used to control the heartbeat. A doctor decides this after tests.

When to see a doctor

You do not need to wait for emergency signs to ask for advice. If palpitations worry you, a routine appointment is a sensible step. Bring a list of your medicines, including any you buy without a prescription, because the NHS says some medicines can cause palpitations.

The NHS suggests seeing a doctor, not urgently, if you feel well but:

• Palpitations keep coming back or happen more often
• They last more than a few minutes
• You already have a heart condition
• You have a family history of heart problems

Get urgent help if palpitations do not go away, or if you also have chest pain, shortness of breath or feel faint. The NHS says to call emergency services or go to hospital in that case, not to drive yourself, and to ask someone to take you or call for an ambulance. Take your medicines with you. If these symptoms have stopped, get an urgent appointment or call a health helpline.

In an emergency, call your local emergency number (112 in India, 911 in the United States).