Palpitations

Heart palpitations are a common experience where your heartbeat becomes more noticeable or feels unusual. While they can be alarming, most palpitations are harmless and caused by everyday factors like stress, caffeine, or exercise.

Table of contents

• What Are Heart Palpitations?
• What Do Palpitations Feel Like?
• How Long Do Palpitations Last?
• What Causes Heart Palpitations?
• When Do People Experience Palpitations?
• When to Seek Medical Help
• How Are Palpitations Diagnosed?
• Treatment Options
• What You Can Do at Home
• How Common Are Palpitations?

What Are Heart Palpitations?

Heart palpitations are feelings of having a fast-beating, fluttering, or pounding heart^[1]. You may feel like your heart is racing, pounding, flip-flopping, missing beats, or skipping a beat^[2]. Palpitations are essentially an increased or abnormal awareness of your heartbeat^[4].

You can feel palpitations in your chest, throat, or neck^[1]. Some people describe seeing their chest move or “flutter,” though this may suggest chest wall muscle movements^[4]. Palpitations can happen at any time, even when you’re resting or doing normal activities^[1].

Although heart palpitations can be worrisome, they’re usually harmless^[2]. However, they can sometimes be related to an abnormal heart rhythm that needs medical attention^[1].

What Do Palpitations Feel Like?

When you have heart palpitations, your heartbeat feels uncomfortable or unusual^[5]. People describe the sensation in different ways. Your heartbeat may feel like it is^[5]:

• Racing or beating very fast
• Irregular, with skipped or extra beats (called ectopic beats)
• Pounding or thumping
• Fluttering
• Flip-flopping
• Having an extra beat
• Missing a beat

Some people also describe a fleeting “sinking” feeling, which is particularly common in patients with isolated extra heartbeats and may correspond to the pause after an extra beat^[4]. You may be able to hear your heart beating, usually when you are in bed at night^[7].

How Long Do Palpitations Last?

Heart palpitations usually don’t last long. They typically last a few seconds or minutes, but they sometimes last longer^[1]. Heart palpitations can last seconds, minutes, or longer^[5]. If you’re having heart palpitations all day, you should check with your healthcare provider, as most heart palpitations don’t last long^[1].

What Causes Heart Palpitations?

Heart palpitations are common and not usually a sign of anything serious^[5]. A wide variety of things can cause heart palpitations^[1]. The most common causes include stress, anxiety, and everyday lifestyle factors.

Emotional and psychological causes include strong emotions such as anxiety, stress, fear, and panic^[1]. Emotional stress can trigger the release of adrenaline, a hormone that increases heart rate^[3]. Heart palpitations can be part of your body’s reaction to feelings of anxiety or panic^[1].

Lifestyle factors that can trigger palpitations include^[1][5]:

• Strenuous exercise
• Lack of sleep
• Caffeine (from coffee, tea, cola, and chocolate)
• Alcohol
• Nicotine and tobacco
• Recreational drugs such as cocaine and amphetamines
• Spicy or rich foods

Medical conditions that may cause palpitations include^[1][5][7]:

• Overactive thyroid (hyperthyroidism)
• Fever
• Anemia (low blood count)
• Low blood sugar levels
• Dehydration
• Blood loss
• Low levels of potassium or oxygen
• Low blood pressure
• Heart rhythm problems (arrhythmias)
• Heart disease
• An abnormal heart valve

Medications and substances that can cause palpitations include^[1][6]:

• Asthma inhalers
• Beta-blockers for high blood pressure or heart disease
• Thyroid drugs
• Some cough and cold medicines, including decongestants
• Diet pills
• Some herbal and nutritional supplements

Pregnancy can also cause palpitations. When you’re pregnant, your heart rate and the amount of blood circulating in your body increase to support your baby, making palpitations common and usually harmless^[1].

When Do People Experience Palpitations?

You can get heart palpitations at different times in your life and in different situations^[1]. Some people experience palpitations as teenagers, during pregnancy, or during menopause^[1].

Heart palpitations after eating can occur, especially after heavy meals rich in carbohydrates, sugar, or fat. Sometimes eating foods with a lot of monosodium glutamate (MSG), nitrates, or sodium can bring them on. Spicy or rich foods can cause palpitations, and so can caffeinated drinks or alcohol^[1][6].

Heart palpitations at night are just like daytime palpitations, but you may notice them more at night because you’re not busy or distracted^[1]. You might have palpitations during the day too, but you’re just too busy to notice them^[6].

Heart palpitations when lying down can occur because sleeping on your side may increase pressure in your body, which can cause palpitations^[1]. You might have palpitations when sitting or lying still, bending over, or moving slowly^[7].

Heart palpitations during exercise are common. The harder your body is working, the more blood your heart needs to pump, so the rate at which your heart beats must increase^[3]. Intense physical activity can cause temporary palpitations^[3].

When to Seek Medical Help

Although most heart palpitations aren’t cause for concern, it’s important to understand when they may signal something more serious^[3].

Call emergency services (999, 911, or 000) immediately if you have heart palpitations along with any of these symptoms^[5][7]:

• Chest pain or discomfort
• Shortness of breath or severe breathlessness
• Feeling faint, fainting, or losing consciousness
• Severe dizziness or light-headedness

See a doctor if^[2][5][3]:

• Palpitations keep coming back or they’re getting worse
• They last longer than a few minutes
• They’re occurring more frequently over time
• You have a history of heart disease or heart problems in your family
• You have a heart condition
• You are at high risk of developing heart disease

Palpitations are more likely to be related to an abnormal heart rhythm if you have heart disease, significant risk factors for heart disease, or an abnormal heart valve^[1].

How Are Palpitations Diagnosed?

To diagnose palpitations, a healthcare provider will do a physical exam and listen to your heart using a stethoscope. They will look for signs of medical conditions that can cause heart palpitations, such as a swollen thyroid gland. You will likely be asked questions about your medical history^[8].

Your doctor may ask you to describe the sensation in detail. They may ask you to tap out the rhythm or choose from several rhythms they demonstrate. This can help identify the type of heart rhythm problem, though a conclusive diagnosis depends on recording your heart’s electrical activity during a symptomatic episode^[4].

Tests that may be recommended include^[8]:

Electrocardiogram (ECG or EKG): This quick and painless test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. An ECG can show if the heart is beating too slow, too fast, or not at all^[8].

Holter monitoring: This portable ECG device is worn for a day or more to record the heart’s rate and rhythm during daily activities. It’s used to detect heart palpitations that aren’t found during a regular ECG exam. Holter monitoring for 24 to 48 hours may be appropriate in patients with daily palpitations^[8].

Event recording: If you don’t have irregular heart rhythms while you wear a Holter monitor, or if the events occur less than once weekly, your healthcare provider might recommend an event recorder. You press a button when symptoms occur. An event recorder is typically worn for up to 30 days or until you have symptoms. When palpitations occur unpredictably or do not occur daily, an initial two-week course of continuous closed-loop event recording is indicated^[8].

Echocardiogram: This noninvasive exam uses sound waves to create moving pictures of the heart. It can show blood flow and structure problems with the heart^[8].

Some personal devices, such as smartwatches, offer remote ECG monitoring. You can ask your healthcare provider if this is an option for you^[8].

Treatment Options

Treatment for heart palpitations depends on the cause. They often do not need to be treated^[5]. Unless the palpitations are caused by a heart condition, heart palpitations rarely require treatment^[8].

After your doctor determines the cause of your palpitations, they can prescribe the appropriate medication if needed^[13]. If your palpitations are caused by a heart problem, you may need medicines or a procedure to help correct your heartbeat^[5].

In most cases, no medical treatment will be needed. Other times, heart palpitations are treated with lifestyle changes or medication^[13].

What You Can Do at Home

There are several things you can do to help control heart palpitations^[13][5][12]:

Avoid triggers: Avoiding things that can trigger palpitations can help. This includes^[5][13]:

• Limiting or avoiding alcohol
• Limiting caffeine
• Avoiding smoking and tobacco products
• Avoiding illegal drugs such as cocaine and amphetamines
• Avoiding activities and medications that seem to trigger palpitations

Reduce stress and anxiety: Your anxiety level can be reduced through^[13][12]:

• Deep breathing or relaxation exercises
• Meditation
• Yoga or tai chi
• Journaling
• Spending time outdoors
• Taking short breaks from work or school

Try vagal maneuvers: The vagus nerve connects the brain to the heart, and stimulating it may calm palpitations. These techniques include^[12]:

• Holding your breath and pushing down, as though having a bowel movement
• Placing ice or a cold, damp towel on the face for a few seconds
• Splashing cold water on the face
• Chanting “Om”

Before trying vagal maneuvers, you should speak with a doctor, who can advise on the most suitable techniques^[12].

Maintain a healthy lifestyle^[13][12]:

• Exercise regularly (but avoid activities that trigger palpitations)
• Eat a well-balanced diet rich in nutrients, fruits, and vegetables
• Stay hydrated, as dehydration can cause palpitations
• Maintain healthy electrolyte levels (potassium, calcium, and magnesium)
• Try to reach and maintain a healthy weight
• Manage stress

When palpitations occur: If you have palpitations again, take deep breaths and try to relax. If you start to feel light-headed, sit or lie down immediately to avoid injuries that might result if you pass out and fall^[19].

Keep a record: If your doctor recommends it, keep a record of your palpitations. Write down the date and time, your pulse, whether your heart rhythm was regular or irregular, what you were doing when the palpitations started, how long they lasted, any other symptoms, and what may have helped your symptoms go away^[19].

How Common Are Palpitations?

Heart palpitations are very common^[1]. Anyone can have heart palpitations, but they’re more common in females^[1]. One study found that 16% of people saw their primary care provider because they had palpitations. Also, heart palpitations are one of the most common reasons people visit a cardiologist^[1].

Palpitations are something that most of us experience at times^[18]. Nearly everyone has palpitations from time to time^[19]. Many people live with palpitations without incident^[20].