Heart palpitations

Heart palpitations are feelings that make you unusually aware of your heartbeat. Your heart may seem to race, pound, flutter, or skip a beat. You may notice the feeling in your chest, throat, or neck.

Palpitations are a symptom, not a diagnosis. They often happen because of stress, physical activity, caffeine, or lack of sleep. Sometimes they are caused by an abnormal heart rhythm, called an arrhythmia, or another medical condition.

An ectopic beat is an early or extra heartbeat. It can create a brief thump or skipped-beat feeling. Ectopic beats are one possible cause of palpitations, but the terms do not mean exactly the same thing.

Palpitations can feel like:

• A fast or racing heartbeat
• Pounding or strong beats
• Fluttering in the chest
• A brief pause followed by a heavy thump
• Skipped, extra, or uneven beats

An episode may last for a few seconds or several minutes. Some palpitations begin and end suddenly, while others build gradually. They may happen while you are active, resting, lying down, or trying to sleep.

Your pulse may be fast, slow, or irregular during an episode. However, some people feel palpitations even when their heart rate is within its usual range.

Everyday triggers are common. These include stress, anxiety, excitement, strenuous exercise, lack of sleep, dehydration, and fever. Caffeine, alcohol, nicotine, energy drinks, and recreational stimulant drugs may also bring on palpitations.

Some medicines can affect your heartbeat. Examples include certain cold remedies, asthma inhalers, thyroid medicines, and stimulant medicines. Do not stop a prescribed medicine without medical advice.

Hormone changes during pregnancy, menstrual cycles, or menopause can make the heartbeat more noticeable. Pregnancy also increases the amount of blood the heart pumps.

Other possible causes include an overactive thyroid, anaemia, low blood sugar, or changes in body salts such as potassium. Anaemia means that the blood does not carry enough oxygen.

Less commonly, palpitations come from an arrhythmia. Examples include atrial fibrillation, which causes an irregular heartbeat, and supraventricular tachycardia, which causes sudden episodes of a very fast heartbeat. Heart valve or heart muscle conditions can also cause palpitations.

Call emergency services if palpitations occur with:

• Chest pain, pressure, or tightness
• Severe trouble breathing
• Fainting, collapse, or difficulty waking
• New confusion, weakness, or signs of a stroke
• Severe dizziness or a feeling that you may pass out

Do not drive yourself if you feel faint or seriously unwell.

Seek urgent, same-day medical advice if a new episode does not settle, repeatedly returns during the day, or your heartbeat remains unusually fast or irregular. You should also seek prompt advice if you have known heart disease or are pregnant and develop persistent palpitations.

Book a routine appointment if episodes keep returning, are becoming more frequent, last more than a few minutes, or interfere with sleep or activity. Arrange an assessment if they happen during exercise or if close relatives have had serious inherited heart problems or an unexplained sudden death.

A healthcare professional will ask what the palpitations feel like, when they happen, and how long they last. They may ask about exercise, stress, sleep, caffeine, alcohol, medicines, drug use, pregnancy, and other symptoms.

They will usually check your pulse and blood pressure and listen to your heart. An electrocardiogram, or ECG, records the heart's electrical activity. It may identify an abnormal rhythm if the palpitations are happening during the test.

Because episodes can come and go, you may be asked to wear a portable heart monitor for a day or longer. An event monitor can be used over a longer period and records the rhythm when symptoms occur.

Blood tests may check for anaemia, thyroid problems, or abnormal levels of body salts. An echocardiogram, which is an ultrasound scan of the heart, may be arranged if there are signs of a heart structure or valve problem.

Keeping a note of when episodes happen, their duration, possible triggers, and other symptoms can help. A smartwatch recording may also be useful, but it cannot confirm or rule out every heart rhythm problem.

Treatment depends on the cause. Palpitations caused by occasional ectopic beats or everyday triggers may not need specific medical treatment. If another condition is responsible, treating that condition may reduce the episodes.

You can try to identify patterns and reduce triggers that clearly affect you. This may include getting enough sleep, staying hydrated, cutting back on caffeine or energy drinks, limiting alcohol, and avoiding nicotine or recreational stimulants.

Stress-reduction methods, such as slow breathing or relaxation exercises, may help when stress is a trigger. They should not be used to dismiss persistent symptoms or emergency warning signs.

Check the labels of non-prescription cold or energy products for stimulants. Speak with a pharmacist or prescriber if you think a medicine is contributing. Do not change or stop prescribed treatment on your own.

Some arrhythmias need medicines or a procedure. A procedure called catheter ablation uses thin tubes passed into the heart to treat the small area causing certain abnormal rhythms. These options are considered only after the rhythm and its cause have been assessed.

Brief palpitations linked to stress, caffeine, poor sleep, or isolated ectopic beats often settle when the trigger passes. They may still return from time to time.

If episodes are caused by an arrhythmia or another health condition, the outlook depends on that cause. Monitoring can help connect your symptoms with your heart rhythm and guide treatment.

Even if a previous episode was harmless, seek reassessment if the pattern changes. Longer episodes, symptoms during exercise, fainting, chest discomfort, or breathlessness deserve particular attention.

Are palpitations the same as a heart attack?

No. Palpitations describe awareness of the heartbeat and have many possible causes. A heart attack more often causes chest pressure or pain, sweating, nausea, or breathlessness, although symptoms differ. Call emergency services if palpitations occur with chest pain or severe illness.

Can anxiety cause palpitations?

Yes. Stress and anxiety can increase adrenaline, making the heart beat faster or more strongly. However, it is best not to assume anxiety is the cause when symptoms are new, persistent, worsening, or associated with warning signs.

Should I exercise if I have palpitations?

Stop and rest if palpitations begin during exercise. Seek urgent help if they occur with chest pain, severe breathlessness, faintness, or collapse. Repeated exercise-related episodes should be assessed before you return to strenuous activity.

Can caffeine trigger palpitations?

It can for some people. Sensitivity differs, so noting whether symptoms follow coffee, tea, cola, or energy drinks may help identify a pattern.