Heart Palpitations: Causes, Symptoms and Treatment

Heart palpitations are the uncomfortable awareness of your own heartbeat. In medicine, this is called palpitation. Palpitations can be felt as a fast, strong, uneven, or unusual heartbeat. The feeling differs from person to person and is described as “my heart feels like it is going to jump out of my chest,” “something is fluttering inside me,” “my heart stops, then thumps,” or “I feel a throbbing in my neck.”

There is an important point to keep in mind: palpitations on their own are not a disease; they are a symptom. So the feeling of palpitation is the shared expression of many different situations. Sometimes it points to a real glitch in the heart, and sometimes it just means a healthy heart’s beats are being felt more than usual. So saying “I have palpitations” alone shows neither danger nor safety. What truly matters is understanding the features of the palpitation.

Are palpitations always a disease?

No. A healthy person also notices their heartbeat now and then during the day. When we are excited, scared, running, running a fever, or having had coffee, the heart beats faster. This is the body’s normal response, because at that moment more blood needs to reach the tissues. These palpitations are temporary and settle on their own once the trigger is gone.

In some people, the body is built to feel its own beats more strongly. Hearing the heartbeat in a quiet setting, when lying in bed, or just before falling asleep is common in this group. This does not mean the heart is truly working differently; awareness has simply gone up. This topic is covered in more detail in the palpitations starting when lying down article.

What is seen as a medical concern is when the heart beats unusually with no clear reason, at rest, or in a setting that does not call for a faster beat. In that case, an underlying cause is looked for.

What causes palpitations?

Many different conditions can lie behind palpitations. Thinking of them in three main groups makes them easier to grasp.

Causes from the heart’s electrical system form the most important group. In this case, the heart truly beats in an unusual way. Premature beats (extrasystoles) are early heartbeats before their turn, and patients often feel them as “skips.” Tachycardia means a fast heartbeat and has different types. Supraventricular tachycardia is fast palpitation that comes in episodes, starting and stopping suddenly. Atrial fibrillation is a fast and irregular rhythm. Wolff Parkinson White (WPW) syndrome leads to palpitation episodes due to an extra electrical pathway present from birth.

Non-cardiac medical causes are also frequent reasons for palpitations. An overactive thyroid keeps the heart racing. Anemia makes the heart work harder so the body can take in enough oxygen. Fluid loss, infections with fever, low blood sugar, and electrolyte imbalances (especially changes in blood potassium and magnesium levels) can lead to palpitations. Some medications cause palpitations as a side effect; asthma medications, cold medicines, some antidepressants, and thyroid hormone are examples.

Lifestyle and psychological factors are also common. Caffeine (coffee, tea, energy drinks, cola), alcohol, smoking, and recreational drugs stimulate the heart. Lack of sleep and extreme tiredness make the heart’s electrical system more sensitive. Stress, anxiety, and panic attacks are strong sources of palpitations; in these patients, palpitation comes as an attack along with fear and a feeling of not being able to breathe.

Palpitations are also common during pregnancy. In this period, blood volume rises, the heart works harder, and hormonal changes affect the rhythm.

What do palpitations feel like?

How the palpitation feels is a strong clue about what lies behind it.

Fast and steady palpitation: The heart suddenly speeds up, the beats one after the other are even, and then it stops suddenly. This pattern often points to attack-like situations such as supraventricular tachycardia.

Fast and irregular palpitation: The heart beats both fast and unevenly. There is a sense that “you cannot tell what speed it will beat at next.” This description often points to atrial fibrillation.

Skipping feeling: The patient describes it as “my heart skips a beat” or “it stops, then thumps hard.” This feeling is the typical description of premature beats. The heart does not actually stop; the short pause after the early beat and the stronger beat that follows create this impression.

Slow but strong palpitation: The heart rate is normal or even on the low side, but the beats feel stronger than usual. This often has to do with raised awareness, especially when lying down or in quiet surroundings.

Throbbing in the neck and chest: In some types of palpitations, especially in supraventricular tachycardia, the patient feels the veins in the neck throbbing clearly.

These differences carry important clues for diagnosis. When seeing the doctor, how the palpitation began, how long it lasted, how it ended, and any accompanying symptoms should be shared.

Are palpitations dangerous?

There is no single answer to this question; it depends on the type, the cause, and accompanying symptoms.

The vast majority of palpitations are harmless and not life-threatening. Palpitations from excitement, caffeine, stress, or lack of sleep are not dangerous. Most premature beats are harmless. Supraventricular tachycardia is bothersome but, when there is no structural heart disease, not life-threatening.

But some situations call for attention. If palpitations come with fainting, dizziness, vision loss, chest pain, shortness of breath, or sudden weakness, the picture is different. These symptoms point to the heart not pumping enough blood or to a more serious rhythm disorder.

For people with a known heart condition, a previous heart attack, or heart failure, every new palpitation should be reviewed carefully. People with a family history of sudden death at a young age should also not take palpitations lightly.

Which palpitations should worry you?

Palpitations with the following features call for review.

Palpitations that come on suddenly and last long (going on for hours), come back often, are irregular, come along with other symptoms (chest pain, shortness of breath, fainting, dizziness, arm numbness), come on during exercise or limit exercise, wake the person from sleep at night, or appear in someone with a family history of sudden death at a young age.

Apart from these, if you have palpitations and feel unease without a clear reason, seeing a doctor is also the right step. The result is most often harmless; but knowing this brings peace of mind.

How is the cause found?

The evaluation of palpitations starts with a detailed history. The doctor asks how the palpitation began, how long it lasted, in what setting it appeared, how it ended, and what other symptoms came along with it. This information guides the diagnosis.

Physical exam and ECG are the first step. An ECG, also called an EKG, is a simple, painless test that turns the heart’s electrical activity into a recording. An ECG taken during the palpitation can often give the diagnosis on its own. But if the palpitation is not happening at the time of the visit, the ECG may look normal, and further tests are needed.

A Holter monitor is a small portable device. It is worn for 24 to 48 hours and records every heartbeat during that time. The patient takes it home and goes about daily life. If palpitations occur, the device captures the rhythm at that moment.

For patients with rare attacks, recording devices worn for a week or longer can be used. For those with very rare attacks, small devices placed under the skin that record for months may be considered.

To assess the heart’s structure, an echocardiogram is done. An echocardiogram is a painless imaging test that uses sound waves to show the structure of the heart. The valves, chamber sizes, and pumping power are evaluated with this test.

Blood tests are usually requested. Thyroid hormones, anemia, kidney function, and electrolytes are checked. Even these simple tests can reveal a non-cardiac cause behind the palpitations.

In some patients, an exercise test is also done. In this test, the patient walks on a treadmill at a speed that gradually increases, and the ECG is monitored during exercise. It gives valuable information for palpitations that come on with exertion.

What can be done for palpitations?

Treatment is fully shaped by the cause. So talking about a single treatment for palpitations would be misleading.

For people without a clear heart condition and with harmless palpitations, special treatment is often not needed. Cutting back on triggers makes a big difference. Caffeine and alcohol are triggers in many people; limiting them brings a clear drop in palpitations. Quitting smoking, getting regular and enough sleep, balanced nutrition, and regular exercise reduce the frequency of palpitations. Stress management (walking, breathing exercises, relaxation methods) brings notable benefit to most patients.

For palpitations from anxiety or panic attacks, support aimed at this condition is needed. These palpitations are real and should not be brushed off as “made up.” With psychological support and medication when needed, palpitations drop clearly.

When a heart-based rhythm disorder is found, treatment varies by type. Rhythm-controlling medications reduce both how often and how strongly episodes happen. Beta blockers calm the heart’s electrical system and are commonly used. In some patients, catheter ablation offers a lasting solution. Ablation is a procedure where the faulty signal pathway or spot is silenced with energy; it is done with a high success rate especially in conditions like supraventricular tachycardia and WPW.

If a non-cardiac cause is found, that is treated. Thyroid problems are managed, anemia is corrected, electrolyte imbalances are fixed. These steps alone often bring a clear drop in palpitations.

What to do during a palpitation?

There are some things you can do during a palpitation. First, try to stay calm. Panic raises the heart rate even more.

Sit or lie down in a quiet place. Breathe in deeply and slowly. Take in air slowly through your nose for four seconds, then breathe out slowly through your mouth for six seconds. This breathing exercise calms the body and often helps the palpitation settle.

Drink a glass of cold water or splash your face with cold water. The cold stimulus activates the vagus nerve, which has the role of slowing the heart down.

If the palpitation is a sudden and ongoing episode of supraventricular tachycardia type, vagal maneuvers can be tried. These maneuvers are explained in detail in the supraventricular tachycardia article.

If the palpitation does not pass within 20-30 minutes, or if dizziness, near-fainting, chest pain, or shortness of breath comes along, the emergency room should be reached without delay.

When to call the doctor

Palpitations that come on suddenly and last long, palpitations along with fainting, chest pain, shortness of breath, dizziness, or blurred vision, frequent recurring episodes, palpitations that wake you from sleep at night, or palpitations that limit exercise — all call for a doctor’s review.

For people with a known heart condition, a previous heart attack, or heart failure, every new palpitation should be reviewed. People with a family history of sudden death at a young age should also take palpitations seriously.

For someone who has a palpitation for the first time, even if it was short and has passed, going for at least one check-up is the right step. This visit helps draw a roadmap for the future.