About this symptom
Palpitations are a feeling that your heartbeat is more noticeable than usual. Your heart may seem to race, pound or flutter, or to skip or add a beat. You may feel it in the chest, throat or neck, and it can last seconds, minutes or longer.
Most of the time they are not serious. Stress, anxiety, hard exercise, lack of sleep, caffeine, alcohol, tobacco, fever and some medicines are common causes. Less often they come from an abnormal heart rhythm (), anaemia, an overactive thyroid or heart disease, which need to be found. A normal resting pulse is about 60 to 100 beats a minute.
Possible causes
This is not a diagnosis. These are the causes doctors think about, with the ones that are most urgent to rule out first.
- Atrial fibrillationA fast, irregular pulse with palpitations that start suddenly and last seconds to minutes, sometimes with breathlessness, tiredness or dizziness.Read about it
- Heart attackPalpitations with chest pain or tightness, breathlessness, sweating or feeling faint. This needs an ambulance at once.Read about it
- Heart valve diseaseA faulty heart valve can upset the heart's rhythm. It is found with an examination and a heart scan (echocardiogram).Read about it
- Overactive thyroidA fast or irregular heartbeat with weight loss, nervousness, trembling, tiredness and not liking the heat. A blood test shows it.Read about it
- Iron deficiency anaemiaNoticeable heartbeats with tiredness, breathlessness and paler skin than usual.Read about it
- AnxietyPalpitations during worry, stress or a panic attack, with sweating, trembling and a feeling of dread. A first episode still needs checking.Read about it
- Caffeine, alcohol or tobaccoPalpitations soon after tea, coffee, alcohol or smoking, which ease when you cut down.
- Some medicinesCold medicines with decongestants, diet pills, and some medicines for asthma or blood pressure can bring them on. Ask the doctor before stopping any medicine.
When to get help
See a doctor soon if you have:
- Palpitations that keep coming back or are happening more often
- Palpitations that lasted longer than a few minutes but have now stopped
- Your first ever episode of palpitations
- Palpitations with a heart condition, high , diabetes, high or a family history of heart problems
- A pulse over 100 at rest, with no exercise, anxiety or fever
Brief palpitations that pass quickly, when you feel well otherwise and they follow stress, caffeine or exercise, can wait for a routine visit. Note when they happen.
What you can do at home
With any emergency sign, do not stay at home: call for an ambulance first and follow any advice the operator gives.
Do
- Sit down, rest and breathe slowly and steadily
- Cut down on tea, coffee, alcohol and tobacco
- Keep a diary of when it happens, how long it lasts and what you were doing, to spot triggers
- Manage stress with relaxation, yoga or meditation, regular exercise and enough sleep
Do not
- Do not ignore palpitations that come with chest pain, breathlessness or dizziness
- Do not take decongestant cold medicines, diet pills or stimulant drugs without asking a doctor
- Do not stop a prescribed medicine on your own: ask the doctor
What the doctor will do
The doctor will ask what it feels like (racing, pounding or fluttering), whether the beat is regular, whether it starts and stops suddenly, how long it lasts, and when it happens: at rest, with effort or when anxious. They will ask about other symptoms, medicines, caffeine, alcohol, tobacco and other drugs, and heart disease in the family. They will check your pulse and examine you.
Tests may include:
- An , a painless recording of the heart's electrical activity that takes a few minutes
- Blood tests, for example for anaemia, thyroid problems and the level of potassium
- A heart monitor worn for a day or longer (a Holter monitor), if the ECG is normal but symptoms continue
- An , an scan of the heart
Many people need no treatment. If a rhythm problem or another cause is found, treatment depends on it and may include medicines or a procedure.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Palpitations always mean a weak heart or a heart attack.”What is true?
Fact
Palpitations are not serious most of the time, and are often caused by stress, caffeine, exercise or fever. But they can sometimes be a sign of an abnormal heart rhythm, so they should be checked, especially if they are new, keep coming back, or come with chest pain, breathlessness or dizziness.
Myth“It is only anxiety, so no tests are needed.”What is true?
Fact
Anxiety is a common cause, but a heart rhythm problem, anaemia or an overactive thyroid can feel the same. A simple ECG and a few blood tests can tell them apart, so have a first episode checked.
Myth“If it comes and goes, or is over in a minute, it is nothing.”What is true?
Fact
A heart rhythm problem such as atrial fibrillation can start and stop suddenly, and the episodes may last only seconds to minutes. See a doctor if palpitations keep coming back or become more frequent.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Are palpitations dangerous?
Not most of the time. They become more worrying when they last long, keep coming back, or come with chest pain, breathlessness, dizziness or fainting, or if you already have a heart condition. Call for an ambulance if you have those signs with palpitations.
Can stress and anxiety cause palpitations?
Yes. Stress, anxiety and panic attacks are common causes, as are caffeine, alcohol, tobacco and lack of sleep. But a heart or thyroid problem can feel similar, so have a first episode checked rather than assuming it is stress.
What test will I need?
Usually an ECG, a painless test of the heart's electrical activity that takes a few minutes. If it is normal but the palpitations continue, you may be asked to wear a heart monitor for a day or longer, or have blood tests.
What should I do when I feel palpitations?
Sit down, rest and breathe slowly, and note when it started and what you were doing. If it settles and there are no other signs, mention it to a doctor. If it does not go away, or comes with chest pain, breathlessness or dizziness, call for an ambulance.
