Heart palpitations are heartbeats that suddenly become more noticeable. Your heart may feel like it’s pounding, fluttering or beating irregularly, often for just a few seconds or minutes. You may also feel these sensations in your throat or neck.
Palpitations may seem alarming, but in most cases they’re harmless and are not a sign of a problem with your heart.
However, palpitations accompanied by other symptoms, such as dizziness or tightness in your chest, can sometimes be a sign of a heart problem.
You should visit your GP if you have palpitations along with other symptoms or if you’re concerned.
What causes heart palpitations?
Palpitations may be triggered by a surge of adrenaline, a hormone your body releases after you have overexerted yourself or when you feel nervous, anxious or excited.
Eating rich, spicy foods, drinking excessive amounts of caffeine or alcohol, smoking, and using recreational drugs can all bring on palpitations.
If you think lifestyle factors are causing your palpitations, try to reduce your stress levels by using relaxation techniques and moderating the level of exercise you do.
You should also reduce your intake of coffee or energy drinks and avoid using recreational drugs.
If you have regular palpitations and also have feelings of anxiety, stress and panic, you may be experiencing panic attacks.
A panic attack can cause an overwhelming sense of anxiety, fear and apprehension, accompanied by nausea, sweating, trembling and palpitations.
Panic attacks can be frightening and intense, but aren’t usually dangerous. Read more about panic attacks.
Less commonly, palpitations can be a side effect of some types of medicine, such as asthma inhalers or tablets for a thyroid problem.
Speak to your GP if you think medication may be responsible for your palpitations. Don’t stop taking a prescribed treatment without first consulting your GP.
Periods, pregnancy and the menopause
Palpitations can sometimes be the result of hormonal changes during a woman’s periods, during pregnancy, or around the time of the menopause. However, these are usually only temporary and not a cause for concern.
The following conditions can make the heart beat faster, stronger or irregularly, and can be a cause of heart palpitations:
- an overactive thyroid
- a low blood sugar level
- some types of low blood pressure
- a high temperature (fever) of 38C (100.4F) or above
- dehydration (not enough fluid in the body)
- a heart problem (see below)
When you may have a heart problem
If you start to experience palpitations more often, or if they get worse or occur with other symptoms such as dizziness or tightness in your chest, see your GP. You may have a heart rhythm problem (arrhythmia), such as atrial fibrillation or supraventricular tachycardia (SVT).
There are also other, less common, heart rhythm conditions that may be the cause of your palpitations. These can be determined by appropriate tests. When your GP or hospital discovers the exact problem with your heart, ask them to explain it to you.
Atrial fibrillation is one of the most common heart rhythm problems and is a major cause of stroke (a serious medical condition that can cause permanent disability).
In the UK, atrial fibrillation affects up to 800,000 people, and is most common in those over 55 years of age. It causes a fast, irregular pulse, which can cause a persistent heart flutter.
You may also feel dizzy, short of breath and very tired. Atrial fibrillation is not usually life threatening, but can be uncomfortable and often needs treating.
Supraventricular tachycardia (SVT)
Supraventricular tachycardia (SVT) is a similar heart rhythm problem to atrial fibrillation. It also causes episodes of an abnormally fast heart rate, but the heart rate is often steady and not irregular.
Episodes of SVT are usually harmless and tend to settle down on their own without the need for treatment. However, you should seek medical advice if you have prolonged episodes of SVT.
Normally the heart beats 60 – 100 times per minute. The rate may drop below 60 beats per minute in people who exercise routinely or take medicines that slow the heart.
If your heart rate is fast (over 100 beats per minute), this is called tachycardia. A heart rate slower than 60 is called bradycardia. An occasional extra heartbeat is known as extrasystole.
Palpitations are not serious most of the time. Sensations representing an abnormal heart rhythm (arrhythmia) may be more serious.
The following conditions make you more likely to have an abnormal heart rhythm:
- Known heart disease at the time the palpitations begin
- Significant risk factors for heart disease
- An abnormal heart valve
- An electrolyte abnormality in your blood — for example, a low potassium level
Heart palpitations can be due to:
- Anxiety, stress, panic attack, or fear
- Caffeine intake
- Nicotine intake
- Cocaine or other illegal drugs
- Diet pills
However, some palpitations are due to an abnormal heart rhythm, which may be caused by:
- Abnormal heart valve, such as mitral valve prolapse
- Abnormal blood level of potassium
- Certain medicines, including those used to treat asthma, high blood pressure, or heart problems
- Overactive thyroid
- Low level of oxygen in your blood
- Lower your intake of caffeine and nicotine. This will often reduce heart palpitations.
- Learn to reduce stress and anxiety. This can help prevent palpitations and help you better manage them when they occur.
- Try deep relaxation or breathing exercises.
- Practice yoga, meditation, or tai chi.
- Get regular exercise.
- Do not smoke.
Once a serious cause has been ruled out by your doctor, try not to pay close attention to heart palpitations. This may cause stress. However, contact your doctor if you notice a sudden increase or a change in them.
When to Contact a Medical Professional
Your GP will often carry out an electrocardiogram (ECG) to assess your heart rate and rhythm. This may immediately confirm whether there’s a problem and whether treatment is needed.
However, the results of an ECG will often be completely normal if you’re not having palpitations at the time of the test. Further tests may be needed, which may be carried out by your GP or local hospital.
If you have never had heart palpitations before, see your health care provider.
Call 911 or your local emergency number if you have:
- Loss of alertness (consciousness)
- Chest pain
- Shortness of breath
- Unusual sweating,
- Dizziness or light-headedness
Call your doctor right away if:
- You often feel extra heartbeats (more than 6 per minute or coming in groups of 3 or more).
- You have risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
- You have new or different heart palpitations.
- Your pulse is more than 100 beats per minute (without exercise, anxiety, or fever).
What to Expect at Your Office Visit
Your doctor or nurse will examine you and ask questions about your medical history and symptoms.
You may be asked:
- Do you feel skipped or stopped beats?
- Does your heart rate feel slow or fast when you have the palpitations?
- Do you feel a racing, pounding, or fluttering?
- Is there a regular or irregular pattern to the unusual heartbeat sensations?
- Did the palpitations begin or end suddenly?
- When do the palpitations occur? In response to reminders of a traumatic event? When you are lying down and resting? When you change your body position? When you feel emotional?
- Do you have any other symptoms?
An electrocardiogram will be done.
In the emergency room, you will be connected to a heart monitor.
If your doctor finds you have an abnormal heart rhythm, other tests may be done. This may include:
- Holter monitor for 24 hours, or another heart monitor for two weeks or longer
- Electrophysiology study (EPS)
- Coronary angiography
Adopting a healthy lifestyle, including a heart healthy diet and regular exercise, may help prevent palpitations.
Heartbeat sensations; Irregular heartbeat; Palpitations; Heart pounding or racing