Heart Palpitations: Causes, Symptoms & When to Worry
📊 Quick facts about heart palpitations
💡 Key takeaways about heart palpitations
- Most palpitations are harmless: About 85-90% of heart palpitations are benign and caused by stress, caffeine, lack of sleep, or exercise
- Know the warning signs: Seek emergency care if palpitations occur with chest pain, fainting, severe breathlessness, or last more than a few minutes
- Lifestyle matters: Reducing caffeine, alcohol, stress, and getting adequate sleep can significantly reduce palpitations
- An ECG can provide answers: If you have recurring palpitations, an ECG or Holter monitor can identify underlying rhythm disorders
- Treatment is available: When treatment is needed, options include medications, lifestyle changes, or catheter ablation for certain arrhythmias
What Are Heart Palpitations?
Heart palpitations are sensations that your heart is beating too fast, too hard, fluttering, or skipping beats. They can be felt in your chest, throat, or neck. Most palpitations are harmless, but some may indicate an underlying heart rhythm disorder that needs evaluation.
Your heart normally beats between 60 and 100 times per minute when you are at rest. When you exercise, become frightened, or feel stressed, your heart naturally beats faster. This is part of your body's normal "fight or flight" response and is not harmful. You might also notice your heart beating when you stand up quickly or after consuming caffeine.
Heart palpitations are an awareness of your heartbeat that feels abnormal or uncomfortable. Many people describe them as a fluttering, pounding, racing, or thumping sensation. Some feel as though their heart is "skipping beats" or "stopping and starting." The sensation can last just a few seconds or continue for minutes.
While the experience can be frightening, it's important to understand that palpitations are extremely common. Research shows that approximately 16% of people experience palpitations at some point in their lives, making it one of the most common reasons for visiting a doctor. The vast majority of cases are benign and do not indicate a serious heart problem.
However, palpitations can sometimes be a symptom of an arrhythmia (abnormal heart rhythm). About 10-15% of patients with palpitations have an underlying arrhythmia that may benefit from treatment. This is why it's important to understand the difference between harmless palpitations and those that warrant medical attention.
Your heart's rhythm is controlled by electrical signals that travel through the heart muscle in a coordinated pattern. These signals originate in the sinoatrial (SA) node, your heart's natural pacemaker. Any disruption in this electrical system can cause the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly. Premature heartbeats, often described as "extra beats" or "skipped beats," are the most common type of arrhythmia and are usually harmless.
How Do Heart Palpitations Feel?
Heart palpitations can feel like your heart is racing, pounding, fluttering, or skipping beats. You may feel them in your chest, throat, or neck. Some people also experience anxiety, breathlessness, fatigue, chest discomfort, dizziness, or sweating during palpitations.
People describe heart palpitations in many different ways, and the sensation can vary from person to person. The experience depends on the type of heart rhythm change occurring and individual sensitivity to heart activity. Some people are more aware of their heartbeat than others, and this awareness alone can sometimes trigger anxiety.
When your heart beats faster than normal, you may feel a rapid pounding or racing sensation in your chest. This can happen suddenly or build up gradually. The heart rhythm may feel regular (each beat evenly spaced) or irregular (beats occurring at unpredictable intervals). Both patterns can be concerning to the person experiencing them, though regular rapid rhythms are often less worrisome.
Extra beats and skipped beats
Premature ventricular contractions (PVCs) and premature atrial contractions (PACs) are the most common causes of the "skipped beat" sensation. These are extra heartbeats that occur slightly earlier than expected in the normal rhythm. After the extra beat, there is typically a brief pause while the heart resets its rhythm, followed by a stronger-than-normal beat as the heart contracts with more blood.
This pattern—extra beat, pause, strong beat—creates the sensation that the heart "jumped," "flipped," or "stopped briefly." The medical term bigeminy refers to a pattern where every other beat is an extra beat, which can be particularly noticeable. Despite feeling dramatic, these extra beats are usually harmless in people with otherwise healthy hearts.
Associated symptoms
During palpitations, you may also experience one or more of the following symptoms:
- Anxiety or a feeling of impending doom – the sensation itself can trigger stress hormones
- Shortness of breath – you may feel you cannot catch your breath
- Fatigue or weakness – particularly with prolonged episodes
- Chest discomfort or mild pain – usually described as pressure rather than sharp pain
- Dizziness or lightheadedness – especially if the heart rate is very fast
- Sweating – part of the body's stress response
- Numbness or tingling sensations – often related to hyperventilation from anxiety
| Sensation | Description | Common causes | Concern level |
|---|---|---|---|
| Skipped beats | Brief pause followed by strong thump | Premature beats (PVCs, PACs), caffeine, stress | Usually low |
| Racing heart | Regular rapid beating, sudden onset | SVT, anxiety, exercise, fever | Moderate – seek evaluation |
| Irregular fluttering | Chaotic rhythm, variable intensity | Atrial fibrillation, multiple PVCs | Higher – needs medical review |
| Pounding at rest | Strong beats at normal or slow rate | Anxiety, heightened awareness, anemia | Low to moderate |
What Causes Heart Palpitations?
Heart palpitations are commonly caused by stress, anxiety, caffeine, alcohol, lack of sleep, fever, certain medications, and hormonal changes. Less common but more serious causes include heart arrhythmias, thyroid disorders, anemia, and underlying heart disease.
Understanding what triggers your palpitations is the first step toward managing them effectively. The causes range from everyday lifestyle factors to medical conditions that require treatment. In many cases, identifying and addressing the trigger can eliminate or significantly reduce palpitations without medication.
Lifestyle and behavioral triggers
Many heart palpitations are caused by factors within your control. These lifestyle triggers stimulate the sympathetic nervous system (your "fight or flight" response) or directly affect the heart's electrical system:
- Stress and anxiety: Emotional stress releases adrenaline and cortisol, which increase heart rate and can trigger palpitations. Anxiety disorders, including panic attacks, are among the most common causes of recurrent palpitations.
- Caffeine: Found in coffee, tea, energy drinks, chocolate, and some medications, caffeine is a stimulant that can increase heart rate and cause irregular beats in sensitive individuals.
- Alcohol: Both acute intoxication and alcohol withdrawal can trigger palpitations. "Holiday heart syndrome" describes arrhythmias that occur after binge drinking, even in otherwise healthy people.
- Lack of sleep: Sleep deprivation puts stress on the body and can increase the frequency of premature beats and palpitations.
- Nicotine: Smoking and nicotine use stimulate the cardiovascular system and can trigger palpitations.
- Certain medications: Decongestants (pseudoephedrine), some asthma inhalers (albuterol), thyroid medications, and stimulant medications can cause palpitations.
- Recreational drugs: Cocaine, amphetamines, and other stimulants can cause dangerous arrhythmias and should be avoided.
Medical conditions that cause palpitations
While lifestyle factors account for most palpitations, several medical conditions can cause or contribute to the sensation:
- Heart arrhythmias: Abnormal heart rhythms such as atrial fibrillation (AFib), supraventricular tachycardia (SVT), ventricular tachycardia, and premature ventricular contractions can cause palpitations. Some arrhythmias require treatment to prevent complications.
- Thyroid disorders: An overactive thyroid (hyperthyroidism) increases metabolism and heart rate, often causing palpitations along with weight loss, tremor, and heat intolerance.
- Anemia: When you have fewer red blood cells to carry oxygen, your heart compensates by beating faster, which can cause palpitations.
- Electrolyte imbalances: Low levels of potassium, magnesium, or calcium can affect the heart's electrical conduction and trigger arrhythmias.
- Heart conditions: Coronary artery disease, heart valve problems, cardiomyopathy, and heart failure can all cause palpitations and require medical evaluation.
- Hormonal changes: Pregnancy, menstruation, perimenopause, and menopause are associated with increased palpitations due to hormonal fluctuations.
- Fever and infection: The body's response to illness often includes increased heart rate.
Palpitations that begin and end abruptly are more likely to represent an arrhythmia like SVT (supraventricular tachycardia). These episodes often last minutes to hours and can sometimes be terminated by specific maneuvers. In contrast, palpitations that build gradually and ease slowly are more often related to anxiety, physical activity, or stimulants.
When Should You See a Doctor for Heart Palpitations?
See a doctor if you have recurring palpitations, if they occur with chest pain, fainting, or severe breathlessness, or if they persist for more than a few minutes. Seek emergency care immediately for palpitations with chest pain, loss of consciousness, or difficulty breathing.
While most heart palpitations are harmless, it's important to recognize when medical evaluation is needed. The key is to distinguish between occasional, short-lived palpitations related to lifestyle factors and those that may indicate a heart condition requiring treatment.
Contact your doctor or a healthcare clinic promptly if you experience any of the following:
- Recurring episodes of palpitations that concern you
- Palpitations that are becoming more frequent or longer-lasting
- Palpitations that occur during physical exertion and cause you to feel faint or very unwell
- Palpitations accompanied by dizziness when you are sitting or lying down
- You have a history of heart disease, high blood pressure, or other cardiovascular conditions
- You have risk factors for heart disease (diabetes, smoking, family history)
- You have irregular heartbeat with chest pain or pressure
- You faint or lose consciousness
- You have severe difficulty breathing
- Palpitations are severe and do not stop after several minutes
These symptoms could indicate a serious arrhythmia or heart attack requiring immediate treatment. Find your emergency number →
What to observe about your palpitations
Before your medical appointment, it helps to gather information about your palpitations that will assist your doctor in making a diagnosis:
- How did they start? Did the palpitations begin suddenly or gradually build up?
- Is the rhythm regular or irregular? Try tapping the rhythm on a surface to demonstrate it to your doctor.
- How fast is your heart beating? Count your pulse for 15 seconds and multiply by 4 to estimate beats per minute.
- What triggers them? Note activities, foods, drinks, emotions, or medications that precede episodes.
- How long do they last? Seconds, minutes, hours?
- What stops them? Do they resolve spontaneously, with rest, or with specific actions?
What Can You Do Yourself for Heart Palpitations?
To reduce heart palpitations: practice relaxation techniques and slow breathing, reduce caffeine and alcohol intake, avoid smoking, get adequate sleep, exercise regularly, and manage stress. During an episode, try the Valsalva maneuver or splashing cold water on your face.
Many people can significantly reduce or eliminate palpitations by making lifestyle changes and learning techniques to calm the heart during episodes. Regular physical activity is particularly beneficial because it paradoxically makes the heart more resilient and less prone to irregular rhythms, and premature beats often diminish during exercise.
Lifestyle modifications
Consider making these changes to reduce the frequency of palpitations:
- Reduce or eliminate caffeine: Try cutting back on coffee, tea, energy drinks, and chocolate to see if your palpitations improve.
- Limit alcohol consumption: Alcohol can trigger palpitations in many people, so reducing intake may help.
- Avoid tobacco and nicotine: Smoking cessation benefits heart health in many ways, including reducing palpitations.
- Get adequate sleep: Aim for 7-9 hours of quality sleep per night.
- Exercise regularly: Moderate aerobic exercise strengthens the heart and often reduces palpitation frequency.
- Manage stress: Consider yoga, meditation, mindfulness practices, or counseling for chronic stress.
- Stay hydrated and maintain electrolyte balance: Dehydration can worsen palpitations.
Relaxation techniques during palpitations
When you feel palpitations starting, try these calming techniques:
Slow, controlled breathing can activate the parasympathetic nervous system (your "rest and digest" response) and help slow the heart. Breathe in slowly through your nose for 4 seconds, hold for 4 seconds, then exhale slowly through your mouth for 6-8 seconds. Repeat this cycle 5-10 times. If you feel tingling or numbness from breathing too fast, breathing into a paper bag briefly can help normalize your blood carbon dioxide levels.
These techniques stimulate the vagus nerve, which can help slow certain types of rapid heart rhythms:
- Valsalva maneuver: Bear down as if having a bowel movement for 10-15 seconds
- Cold water on face: Splash cold water on your face or hold a cold wet cloth to your face
- Coughing: Forceful coughing can sometimes reset heart rhythm
- Carotid sinus massage: Should only be performed by medical professionals
Note: These maneuvers work best for supraventricular tachycardia (SVT) and may not help with all types of palpitations. If symptoms are severe or don't resolve, seek medical attention.
How Are Heart Palpitations Diagnosed?
Diagnosis of heart palpitations involves a physical examination, medical history, and electrocardiogram (ECG). If the ECG is normal but symptoms persist, doctors may use Holter monitors, event recorders, blood tests for thyroid and electrolytes, or echocardiogram to assess heart structure.
When you visit your doctor for palpitations, the evaluation aims to determine whether there is an underlying heart rhythm disorder and, if so, what type. This information guides treatment decisions and helps reassure you about the nature of your symptoms.
Physical examination
Your doctor will perform a comprehensive physical examination that includes:
- Listening to your heart with a stethoscope to detect murmurs or irregular rhythms
- Listening to your lungs for signs of fluid accumulation
- Measuring your blood pressure in different positions
- Checking your pulse for rate and regularity
- Examining your thyroid gland for enlargement
- Looking for signs of anemia (pale skin, pale nail beds)
Electrocardiogram (ECG/EKG)
An electrocardiogram is typically the first test performed. This non-invasive test records the electrical activity of your heart through electrodes placed on your chest, arms, and legs. The ECG can reveal many types of arrhythmias, previous heart attacks, and other cardiac conditions. However, since the test only captures a snapshot of your heart rhythm at that moment, it may appear normal if you are not having palpitations during the recording.
Holter monitor and event recorders
If your ECG is normal but you continue to experience palpitations, your doctor may recommend ambulatory heart monitoring:
- Holter monitor: A portable device worn for 24-48 hours that continuously records your heart rhythm. This helps capture arrhythmias that occur intermittently.
- Event recorder: A device worn for days to weeks that records heart rhythm only when you activate it during symptoms or when it detects an abnormal rhythm.
- Implantable loop recorder: A small device implanted under the skin for long-term monitoring (up to 3 years), useful for infrequent but significant symptoms.
Additional tests
Depending on your symptoms and initial test results, your doctor may order:
- Blood tests: To check thyroid function, electrolyte levels (potassium, magnesium, calcium), and for anemia
- Echocardiogram: An ultrasound of the heart that shows its structure, valve function, and pumping ability
- Exercise stress test: Monitors your heart while you exercise to detect arrhythmias triggered by physical activity
- Electrophysiology study: An invasive test using catheters to map the heart's electrical system, typically reserved for diagnosing specific arrhythmias before treatment
How Are Heart Palpitations Treated?
Treatment for heart palpitations depends on the underlying cause. Lifestyle modifications are first-line for benign palpitations. Medical treatments include beta-blockers, calcium channel blockers, or antiarrhythmic drugs. For certain arrhythmias, catheter ablation, pacemakers, or implantable defibrillators may be recommended.
The treatment approach for heart palpitations is highly individualized, depending on the type and severity of symptoms, the underlying cause, the impact on quality of life, and the presence of other heart conditions. Many people with benign palpitations require no treatment beyond reassurance and lifestyle modifications.
Lifestyle modifications
For most people with benign palpitations, addressing lifestyle triggers is the first and often only treatment needed. This includes reducing or eliminating caffeine, moderating alcohol intake, managing stress through relaxation techniques or therapy, ensuring adequate sleep, and regular physical exercise. Simply understanding that palpitations are harmless can significantly reduce anxiety and the frequency of symptoms.
Medications
When lifestyle changes are not sufficient, or when an arrhythmia is identified that requires treatment, medications may be prescribed:
- Beta-blockers (e.g., metoprolol, atenolol): Slow the heart rate and reduce the force of contractions. Often first-line therapy for various arrhythmias and palpitations related to anxiety.
- Calcium channel blockers (e.g., verapamil, diltiazem): Also slow heart rate and are used for certain types of SVT.
- Antiarrhythmic medications (e.g., flecainide, propafenone, amiodarone): Used for specific arrhythmias when other treatments fail. These require careful monitoring for side effects.
- Blood thinners (anticoagulants): Required for atrial fibrillation to reduce the risk of stroke.
Procedures and devices
For some arrhythmias, more advanced treatments may be recommended:
- Catheter ablation: A procedure where catheters are threaded through blood vessels to the heart, and the abnormal electrical pathways causing the arrhythmia are destroyed using radiofrequency energy or freezing. This can cure many types of SVT and some ventricular arrhythmias.
- Cardioversion: An electrical shock delivered to the heart to restore normal rhythm, typically used for atrial fibrillation or flutter.
- Pacemaker: A small device implanted under the skin that helps regulate slow heart rhythms. Some pacemakers can also control fast rhythms.
- Implantable cardioverter-defibrillator (ICD): A device that monitors heart rhythm and delivers shocks to correct dangerous ventricular arrhythmias. Used for high-risk patients.
Heart palpitations are common during pregnancy due to increased blood volume and hormonal changes. Most are harmless, but any new or concerning symptoms should be evaluated by your doctor. Some medications used for arrhythmias are safe during pregnancy, while others should be avoided. If you experience palpitations during pregnancy, discuss safe management options with your healthcare provider.
How Can You Prevent Heart Palpitations?
Prevent heart palpitations by maintaining a healthy lifestyle: regular exercise, balanced diet, adequate sleep, stress management, limiting caffeine and alcohol, avoiding tobacco, and managing underlying health conditions like thyroid disorders or heart disease.
While not all palpitations can be prevented, particularly those related to structural heart disease or genetic arrhythmias, many episodes can be avoided or minimized by addressing modifiable risk factors. A heart-healthy lifestyle benefits your overall cardiovascular system and may reduce the frequency and severity of palpitations.
Heart-healthy habits
- Exercise regularly: Aim for at least 150 minutes of moderate aerobic activity per week. Regular exercise strengthens the heart and often reduces palpitations.
- Eat a balanced diet: A diet rich in fruits, vegetables, whole grains, lean proteins, and low in processed foods supports heart health.
- Maintain a healthy weight: Excess weight puts strain on the heart and is associated with increased arrhythmia risk.
- Manage blood pressure and cholesterol: Work with your doctor to keep these in healthy ranges.
- Control blood sugar: If you have diabetes, good glucose control reduces cardiovascular complications.
Avoid triggers
- Know your caffeine limit: Some people can tolerate caffeine without issues, while others are very sensitive. Find your threshold.
- Moderate alcohol intake: Binge drinking is particularly associated with arrhythmias.
- Quit smoking: Nicotine is a stimulant that can trigger palpitations and damages blood vessels.
- Review medications: Some over-the-counter medications (like decongestants) and supplements can trigger palpitations. Discuss alternatives with your doctor.
Frequently Asked Questions About Heart Palpitations
Medical References and Sources
This article is based on current medical research and international guidelines. All claims are supported by scientific evidence from peer-reviewed sources.
- European Society of Cardiology (ESC) (2024). "Guidelines for the diagnosis and management of patients with palpitations." Europace Journal European guidelines for arrhythmia diagnosis and management.
- American College of Cardiology/American Heart Association (2023). "ACC/AHA Guidelines on Management of Patients With Supraventricular Tachycardia." Circulation Journal Comprehensive guidelines for SVT management.
- Mayo Clinic Proceedings (2023). "Evaluation and Management of Patients with Palpitations." Mayo Clinic Proceedings Clinical approach to palpitation evaluation.
- Raviele A, et al. (2011). "Management of patients with palpitations: a position paper from the European Heart Rhythm Association." Europace. 13(7):920-934. Evidence-based position paper on palpitation management.
- Weber BE, Kapoor WN (1996). "Evaluation and outcomes of patients with palpitations." The American Journal of Medicine. 100(2):138-148. Landmark study on palpitation outcomes.
- World Health Organization (2023). "Cardiovascular diseases (CVDs) Fact Sheet." WHO Fact Sheets Global cardiovascular health statistics and recommendations.
Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence-based medicine. Evidence level 1A represents the highest quality of evidence, based on systematic reviews of randomized controlled trials.
iMedic Medical Editorial Team
Specialists in cardiology, internal medicine and emergency medicine
Our Editorial Team
iMedic's medical content is produced by a team of licensed specialist physicians and medical experts with solid academic background and clinical experience. Our editorial team includes specialists in cardiology, electrophysiology, and internal medicine.
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Licensed physicians specializing in cardiology and heart rhythm disorders, with documented experience in arrhythmia diagnosis and treatment.
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Academic researchers with published peer-reviewed articles on cardiac electrophysiology in international medical journals.
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Practicing physicians with over 10 years of clinical experience treating patients with palpitations and arrhythmias.
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