Almost everyone has felt their heart skip, flutter, pound or race at some point. These sensations are called palpitations. They can be unsettling, but most are harmless and linked to everyday triggers such as stress, caffeine or poor sleep. Sometimes, though, palpitations signal a heart rhythm problem that needs treatment. This guide explains how to tell the difference.
What palpitations feel like
People describe palpitations in different ways:
- A skipped or “missed” beat, often followed by a hard thump
- Fluttering in the chest
- A pounding heartbeat that you can feel in your chest, throat or neck
- A racing heart, even at rest
- An irregular rhythm that feels chaotic
Common, usually harmless causes
- Extra beats. Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are early beats that interrupt the normal rhythm. They are extremely common, and in people with a healthy heart they are usually benign. The “thump” you feel is often the stronger beat that follows the pause.
- Caffeine, from coffee, tea, energy drinks and some pre-workout supplements
- Nicotine and alcohol
- Stress, anxiety and panic attacks
- Lack of sleep
- Exercise
- Dehydration
- Hormonal changes during periods, pregnancy and perimenopause
- Medicines, including decongestants, some asthma inhalers, thyroid medication and certain antidepressants
- Recreational drugs, such as cocaine and amphetamines
Medical conditions that can cause palpitations
- Atrial fibrillation (AFib), an irregular and often fast rhythm that raises stroke risk
- Supraventricular tachycardia (SVT), sudden episodes of a very fast, regular heartbeat that start and stop abruptly
- Ventricular tachycardia, a dangerous fast rhythm from the lower chambers, usually in people with heart disease
- An overactive thyroid
- Anemia, where the heart pumps faster to deliver oxygen
- Low blood sugar
- Fever and infection
- Heart valve disease or heart muscle disease
Warning signs: get urgent help
Call 911 if palpitations come with:
- Chest pain or pressure
- Fainting or nearly fainting
- Severe shortness of breath
- Sudden weakness, numbness, confusion or trouble speaking
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See a doctor promptly if palpitations:
- Last more than a few minutes or keep coming back
- Feel very fast at rest, or irregular
- Happen during exercise
- Occur in someone with known heart disease, previous heart attack or heart failure
- Come with a family history of sudden cardiac death at a young age
How doctors investigate palpitations
Your doctor will ask what the palpitations feel like, how long they last, what triggers them and whether you have other symptoms. Tapping out the rhythm on a table can help describe it.
Common tests include:
- An ECG (electrocardiogram), which records the heart’s rhythm. It may be normal between episodes.
- Ambulatory monitoring, such as a Holter monitor worn for one to two days, or a patch monitor or event recorder worn for up to several weeks, to catch episodes as they happen.
- Smartwatch recordings. Many watches can record a single-lead ECG. They are not a substitute for medical testing, but recordings taken during symptoms can be very useful to share with your doctor.
- Blood tests for thyroid function, anemia, electrolytes such as potassium and magnesium, and blood sugar.
- An echocardiogram to check the heart’s structure and pumping function.
- An exercise stress test if palpitations happen during activity.
Treatment
Treatment depends on the cause.
For harmless extra beats, reassurance and reducing triggers are often enough. Cutting back on caffeine and alcohol, improving sleep and managing stress usually help. If extra beats are frequent and bothersome, a beta blocker may be prescribed.
For SVT, vagal maneuvers, such as bearing down as if straining or splashing cold water on the face, can sometimes stop an episode. Your doctor can teach you how to do these safely. Medicines can prevent episodes, and catheter ablation can often cure SVT permanently.
For atrial fibrillation, treatment focuses on preventing stroke with anticoagulants when appropriate, controlling the heart rate, and sometimes restoring normal rhythm.
For underlying conditions such as an overactive thyroid or anemia, treating the cause usually stops the palpitations.
Self-help steps
- Keep a diary of when palpitations occur and what you were doing, eating or drinking
- Cut back on caffeine, alcohol and nicotine
- Stay hydrated
- Prioritize sleep
- Practice slow breathing or relaxation techniques
- Review over-the-counter medicines and supplements with a pharmacist
- Exercise regularly once your doctor confirms it is safe
The bottom line
Most palpitations are harmless and linked to everyday triggers. Palpitations that come with chest pain, fainting or severe breathlessness need emergency care, and frequent, prolonged or irregular palpitations deserve a medical evaluation. A simple ECG and heart monitoring can usually find the cause, and most rhythm problems are very treatable.
This article is for general information and does not replace medical advice.