Heart Palpitations: Symptoms, Causes and Care

Heart palpitations may feel like racing, pounding, fluttering, flip-flopping, or skipped heartbeats. They often cause worry, but many cases are harmless. At times, an abnormal heart rhythm causes the feeling and needs medical care ^9,10.

This guide covers the symptoms and causes of heart palpitations, how they are diagnosed, and when to seek care. It also explains heart palpitation tests, common triggers, treatments, and warning signs.

If palpitations occur with chest pain, seek emergency medical care now. Do the same for fainting, severe shortness of breath, or severe dizziness.

Heart palpitations are an increased awareness of the heartbeat ^6,8. They are a symptom, not a diagnosis. The feeling alone cannot show whether the heart rhythm is normal.

People use many words to describe palpitations. Common descriptions include these feelings:

A skipped-beat feeling may come from a premature contraction. This means that one heartbeat occurs earlier than expected ^5,6. Some people then notice a strong beat ⁵.

Palpitations may feel regular or uneven ⁷. They may also seem fast or slow ⁷. Tapping the rhythm with one hand may help a clinician understand it ^7,10.

The feeling may occur in the chest, neck, or throat. Palpitations can happen during exercise, normal activity, or rest ^9,10. Some people notice pounding or jumping while sitting or lying down ⁸.

An episode may last for seconds, minutes, or longer ^6,10. The timing can help guide the choice of heart monitor ^1,8.

Palpitations do not always mean that a harmful rhythm is present. A BMJ review found that more than half of cases were harmless. These cases included extra beats called extrasystoles.

Some people have a normal heart rhythm while they feel palpitations. Other episodes may come from a heart rhythm problem ^6,8,9. Stress, illness, medicines, and drugs can also cause them ^6,8,9,10.

A clinician looks at the whole pattern before making a diagnosis. The history, exam, symptoms, and test results may help reveal the cause ^3,7.

Palpitations are a symptom on their own. Other symptoms may occur at the same time. These added symptoms can affect how soon care is needed.

Details about each episode may provide useful clues. Be ready to describe the following points:

Brief, random episodes are often linked to premature beats. Fast and uneven palpitations are often reported with atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm that may cause palpitations.

These patterns cannot confirm the cause by themselves. A heart rhythm test may be needed to find the cause ^3,7.

Certain symptoms with palpitations require emergency assessment. Follow this guidance when any listed event occurs:

Do not judge the cause from the heartbeat feeling alone. Some people feel palpitations even when the rhythm is normal.

People often ask what causes heart palpitations. Causes include stress, exercise, medicines, illness, and abnormal heart rhythms ^6,8,9,10. Sometimes, tests do not find a clear cause ².

Strong feelings can trigger palpitations. Reported triggers include stress, anxiety, fear, and panic ^9,10. Anxiety is a common cause outside the heart ⁷.

However, anxiety should not be assumed to explain every episode ⁷. A non-mental health cause can also exist in people with anxiety symptoms ⁷.

Exercise can make the heartbeat faster or easier to notice. Other triggers include caffeine, nicotine, alcohol, and stimulant drugs ^5,6,9. Cocaine and amphetamines can also cause palpitations ^6,9,10.

A written record can show links between symptoms and possible triggers. Clinicians ask about exercise, caffeine, alcohol, and drug use during an assessment ².

Prescription and nonprescription products may affect the heartbeat. A clinician may review medicines, supplements, and herbal products during the assessment ¹⁰.

Products linked with palpitations include the following examples:

Bring a current list of medicines and supplements to the appointment. Medical history and symptoms form part of the review ^1,10.

Several health problems outside the heart can cause palpitations. These include fever, anemia, dehydration, pregnancy, and thyroid disease ^6,7,8,9,10. Low blood sugar can also cause palpitations ^6,8,10.

An electrolyte imbalance is another possible cause ^5,6,8. Electrolytes include minerals such as sodium, potassium, and magnesium. Problems with these minerals may trigger palpitations or premature beats ^5,6.

Pregnancy can raise heart rate and the amount of blood in the body ¹⁰. Palpitations during pregnancy are common and often harmless ¹⁰. A pregnant person can discuss the symptoms with a healthcare professional ¹⁰.

An arrhythmia is an abnormal heart rhythm. Possible arrhythmias include premature beats, atrial fibrillation, and supraventricular tachycardia ^3,6,7,8.

Supraventricular tachycardia is a fast rhythm that starts above the lower heart chambers. It is a recognized cardiac cause of palpitations ^3,7,8.

Ventricular tachycardia is another possible cause ^3,6,7,8. This fast rhythm starts in the heart’s lower chambers.

Premature atrial contractions are also called PACs ⁵. Premature ventricular contractions are also called PVCs ⁵. Both types can cause extra or skipped heartbeats ^3,5.

PACs and PVCs are common types of ectopic heartbeats ^3,5. Premature beats do not raise death risk when the heart evaluation is normal ⁸. Their meaning can depend on whether structural heart disease is present.

Atrial fibrillation may cause fast and uneven palpitations. It is linked to an increased risk of stroke. Blood may pool and form clots during atrial fibrillation.

Structural causes include valve disease, heart muscle disease, and heart failure ⁸. Heart disease present from birth is another possible cause ⁸. Imaging may be useful when other findings suggest a structural problem ^3,7.

Diagnosis often starts with a medical history and physical exam ^3,7. Other heart palpitation tests may assess rhythm, blood, or heart structure ^3,7,10.

The clinician may ask when the episodes began and how often they occur. Questions may cover symptoms and whether you have heart disease ². The clinician will also review health problems and medicines ^1,10.

Personal and family history may provide more clues. Some serious heart rhythm conditions may have a hereditary component ⁷. Known heart disease may increase concern about a cardiac cause.

The clinician may listen to the heart and lungs ¹⁰. The exam may check for an uneven pulse or a heart murmur ⁷. These findings may suggest an arrhythmia or structural heart problem ⁷.

A resting 12-lead electrocardiogram is an essential first test. This test is also called an ECG or EKG. It records the heart’s electrical activity.

An ECG may find an arrhythmia or conduction problem ^1,7. A conduction problem affects how electrical signals move through the heart. The test may also show clues linked with heart disease ⁷.

A normal resting ECG does not rule out an occasional rhythm problem ^1,8. The rhythm may be normal while the test takes place. A wearable monitor may still be useful ^1,8.

Targeted blood tests may find problems that cause palpitations. Testing may show anemia, thyroid disease, or an electrolyte imbalance. A clinician can select tests after reviewing the history and exam ^3,7.

An echocardiogram uses sound waves to examine the heart’s size and structure ⁵. Cardiac imaging is advised when other findings suggest structural heart disease. Those findings may come from the history, exam, or ECG.

A Holter monitor records heart rhythm while a person wears it ⁵. Monitoring for 24 to 48 hours may suit symptoms that happen daily ^5,8.

Less frequent symptoms may need longer monitoring. An event or loop monitor can help when episodes do not happen daily ^3,8. This type may also help when episodes are hard to predict ⁸.

Clinicians match the monitoring period to the rate of symptoms. The aim is to record the rhythm during a typical episode ^1,8.

A monitor may find an abnormal rhythm or premature beats. It may instead show a normal rhythm during symptoms. This link between the feeling and rhythm can guide further care.

An isolated heartbeat feeling may not need urgent assessment. Rare episodes lasting only a few seconds may not need evaluation. That guidance applies when no concerning symptoms occur.

Arrange an evaluation if episodes keep returning or become worse ^5,9. Palpitations lasting minutes or hours also deserve medical review. Seek an evaluation when symptoms affect daily life.

A non-emergency appointment may fit these situations:

Keep emergency symptoms separate from non-emergency concerns. If chest pain occurs with palpitations, seek emergency medical care now. If fainting occurs with palpitations, seek emergency medical care now.

If severe breathlessness occurs with palpitations, seek emergency medical care now. If severe dizziness occurs with palpitations, seek emergency medical care now.

Known heart disease may support faster specialist assessment. An abnormal resting ECG can also support referral.

Palpitations with fainting or lightheadedness need careful review. If fainting occurs with palpitations, seek emergency medical care now.

Family history may also provide useful information. Some serious rhythm conditions may have an inherited component ⁷. A clinician may ask about heart problems within the family ⁷.

A cardiology referral is advised when an ECG finds an arrhythmia. Referral is also advised for an electrical conduction problem.

Known heart disease may be another reason for referral. Palpitations linked with fainting or lightheadedness may require specialist care.

Specialist referral is advised for supraventricular tachycardia or ventricular tachycardia. Long QT syndrome also needs cardiology referral. Long QT syndrome affects the heart’s electrical timing.

Palpitations with fainting are another reason for referral. If fainting occurs with palpitations, seek emergency medical care now.

An electrophysiologist is a clinician who treats abnormal heart rhythms ¹⁰. This specialist may help when tests find a rhythm disorder ¹⁰.

Treatment depends on the cause of the palpitations ^5,6,10. Some people do not need treatment ^5,10. Others may need care for an illness or abnormal rhythm ^5,6.

A clear record can make an appointment more useful. A symptom log can include the following details:

Clinicians may ask about possible triggers and related symptoms. This information may help them make a diagnosis ^1,8.

Bring a list of prescription and nonprescription medicines. Include herbal products and food supplements on that list ¹⁰. Discuss any suspected medicine trigger with a healthcare professional before making a change.

Limiting caffeine, alcohol, and tobacco may reduce ectopic beats for some people ⁵. Ectopic beats are changes in a heartbeat that is otherwise normal ⁵. Reducing stimulants may help when they appear to trigger symptoms ^5,6.

Use the symptom log to look for repeat patterns. A clinician can review possible links with medicines, drinks, activities, or drugs ^1,10.

Many ectopic beats do not need treatment ⁵. Treatment may be considered when symptoms are severe or beats happen often ⁵. When needed, care focuses on the symptoms and their cause ⁵.

An electrolyte problem may need correction. A complex arrhythmia may require medicine or a heart rhythm procedure. The exact plan depends on the diagnosis ^5,6,10.

Atrial fibrillation needs medical assessment because it raises stroke risk. Supraventricular tachycardia may need specialist care. Ventricular tachycardia also calls for specialist assessment.

Treatment follows the cause rather than the feeling alone. Recording the rhythm during symptoms may be an important step ^1,8.

Many heart palpitations are harmless, but some should not be ignored. Repeated, worsening, long, or disruptive episodes deserve medical evaluation ^5,6,9.

Knowing the symptoms and causes of heart palpitations, how they are diagnosed, and when to seek care can support sound choices. A symptom log and medicine list can help prepare for an appointment. An ECG, blood test, or heart monitor may help find the cause ^1,6,10.

If palpitations occur with chest pain, seek emergency medical care now. If palpitations occur with fainting, seek emergency medical care now. Severe breathlessness or severe dizziness with palpitations also requires emergency medical care now.

Otherwise, schedule an evaluation when episodes keep returning or become worse ^5,9. Medical review is also reasonable when episodes last longer or disrupt daily life.