Palpitations
Palpitations: A Complete Patient Guide
Palpitations are the awareness of your own heartbeat. People describe them as a racing, pounding, fluttering or thumping heart, or as skipped or extra beats. They are one of the most common reasons for seeing a cardiologist. In most people palpitations are harmless, but occasionally they signal a rhythm problem that needs treatment, so the key question is always: what is the rhythm during the symptoms?
The heart normally beats 60 to 100 times a minute in a regular rhythm, and you do not notice it. Palpitations can occur with a normal rhythm that is simply faster or stronger, such as with anxiety, exercise, caffeine, fever or pregnancy, or with an abnormal rhythm such as extra beats (ectopics), atrial fibrillation or supraventricular tachycardia.
The commonest cause is benign extra beats. The assessment aims to separate benign palpitations from those caused by arrhythmia or heart disease, using your story, an ECG and, most importantly, rhythm monitoring that captures an episode. Most people can be reassured, and those who need treatment have effective options.
Palpitations are described in many ways, and the pattern gives useful clues to the cause.
How palpitations are described
Skipped or missed beats, or a thump followed by a pause: typically ectopic beats
Sudden-onset, sudden-stop fast regular racing: suggests supraventricular tachycardia
Irregular, chaotic fluttering: may indicate atrial fibrillation
Gradual rise and fall of a fast heartbeat with anxiety, fever, exercise or caffeine: usually a normal rhythm (sinus tachycardia)
Symptoms that may come with palpitations
Light-headedness, dizziness or near-fainting
Breathlessness or chest discomfort
Sweating, anxiety or a feeling of dread
Neck pulsations or a sensation of fullness in the throat
Features of a more serious cause
Fainting, or near-fainting, with the palpitations
Chest pain or marked breathlessness
Palpitations on exertion, or during sleep or swimming
A family history of sudden death, cardiomyopathy or inherited heart rhythm conditions
Many things can cause palpitations, and several often combine.
Heart rhythm causes
Ectopic beats (premature atrial or ventricular beats) are by far the most common
Atrial fibrillation and atrial flutter
Supraventricular tachycardia (SVT) and, less commonly, ventricular tachycardia
Slow rhythms such as bradycardia or heart block
Heart structure causes
Heart valve disease, cardiomyopathy, heart failure and previous heart attack can all cause rhythm disturbances.
Triggers and medical causes
Caffeine, alcohol, nicotine, energy drinks and recreational drugs
Anxiety and stress, poor sleep and panic attacks
Overactive thyroid, anaemia, low blood sugar, dehydration, fever and infection
Medicines such as decongestants, asthma inhalers, thyroid tablets and some antidepressants
Pregnancy, the menopause and the menstrual cycle
The aim is to capture the rhythm during symptoms and to exclude underlying heart disease.
1. History and examination
Your cardiologist will ask what the palpitations feel like, how they start and stop, how long they last, triggers, and associated symptoms. A pulse tapping exercise can help to show whether the rhythm is regular. They will also check your pulse, blood pressure and heart sounds.
2. ECG
A resting ECG looks for pre-excitation (a delta wave), a long QT interval, heart block and other abnormalities. A normal ECG between episodes does not exclude an arrhythmia.
3. Rhythm monitoring
The most useful test is to record your rhythm during symptoms. Cardiac monitoring ranges from 24 to 48-hour Holter monitors, through 7 to 14-day patch monitors, to event recorders, smartwatch ECGs or an implantable loop recorder for rare episodes.
4. Blood tests
Blood count, kidney function and electrolytes, thyroid function and sometimes glucose and magnesium look for treatable triggers.
5. Echocardiogram and exercise test
An echocardiogram looks for valve disease, cardiomyopathy and heart weakness. An exercise ECG or stress echo is used if palpitations occur on exertion or coronary disease is suspected.
Treatment depends on the cause, so most people need nothing more than an explanation and reassurance.
Reassurance and self-help
Reduce caffeine, alcohol, nicotine and energy drinks, and avoid recreational drugs
Improve sleep, manage stress and anxiety, stay hydrated, and exercise regularly
Keep a symptom diary of timing and triggers, and learn to check your pulse
Treating fast regular rhythms
Vagal manoeuvres such as the modified Valsalva (blowing into a syringe while lying back, then lifting the legs) can stop SVT
Medicines such as beta-blockers, calcium channel blockers or others can prevent or slow episodes
Catheter ablation can cure SVT and flutter in most people with a success rate of about 90 to 95%
Atrial fibrillation and other rhythms
Stroke prevention with an anticoagulant, rate or rhythm control and treatment of triggers are the principles for atrial fibrillation. Ventricular rhythms and inherited conditions need specialist management.
Ectopic beats
Isolated ectopic beats with a normal heart need no treatment other than reassurance, reducing triggers and, occasionally, a beta-blocker. Very frequent ectopics are assessed for effects on the heart.
Keep a diary of when palpitations occur, what you were doing, how long they lasted and your pulse rate if you can measure it.
Cut down on stimulants: caffeine, energy drinks, nicotine, alcohol and recreational drugs.
Look after sleep, stress and anxiety. Relaxation, breathing exercises and exercise help, and therapy is effective where anxiety drives symptoms.
Smartwatches: they can capture useful rhythm strips, but may cause worry or false alarms. Share recordings with your doctor rather than interpreting them yourself.
Stay hydrated and eat regularly.
Exercise: most people with benign palpitations can exercise normally. Check first if symptoms occur with exertion.
Driving: DVLA rules apply if palpitations cause fainting or dizziness.
Support is available from the Arrhythmia Alliance, the British Heart Foundation and the NHS.
Most palpitations are benign and do not affect life expectancy, particularly when the heart is structurally normal.
When palpitations are due to SVT or flutter, ablation offers a cure in most people.
Palpitations caused by atrial fibrillation need long-term stroke prevention and review.
Palpitations linked to a weak or thickened heart, or to inherited rhythm conditions, need specialist management, and outlook depends on the underlying condition.
Understanding the cause often reduces anxiety, which in turn reduces how much you notice them.
It is sensible to have palpitations assessed at least once, particularly if they are persistent or new.
Arrange an assessment if you have:
Palpitations that are frequent, prolonged or worsening
A very fast heartbeat lasting more than a few minutes, or an irregular pulse
Palpitations with breathlessness, chest discomfort or dizziness
A history of heart disease, valve disease or a family history of heart rhythm problems or sudden death
Palpitations on exercise, or that interfere with sleep or daily life
A smartwatch or home monitor alert for an irregular rhythm
You may be reassured if:
Your palpitations are brief and infrequent, are linked to clear triggers such as caffeine or stress, your examination and ECG are normal, and you have no other symptoms or family history.
Certain features raise concern, and mean you should be assessed promptly, ideally within days.
Red flags
Fainting or near-fainting with palpitations
Palpitations with exertion, or during swimming or after a sudden noise
Chest pain or breathlessness with the palpitations
A very fast pulse (over about 150 per minute) that does not settle
A family history of sudden unexplained death under 40, cardiomyopathy or inherited rhythm disease
Known heart disease, heart failure or previous heart attack
What to do
Arrange an urgent consultation, an ECG and rhythm monitoring. If you can, record your pulse or an ECG strip during an episode.
Palpitations accompanied by the following need emergency help.
Call 999 immediately if you have palpitations with:
Chest pain or pressure that does not settle within minutes, or with sweating or breathlessness
Fainting or collapse
Severe breathlessness or being unable to speak
Signs of a stroke: face drooping, arm weakness or slurred speech
A very fast heartbeat with feeling extremely unwell, confused or grey
If someone collapses
If a person collapses and is not breathing normally, call 999, start CPR and use a defibrillator if one is available.
Palpitations are the awareness of your heartbeat, and most are harmless.
The most common cause is benign extra (ectopic) beats.
Triggers include caffeine, alcohol, stress, poor sleep, thyroid disease and anaemia.
Sudden-onset, sudden-stop racing suggests SVT, and an irregular flutter suggests atrial fibrillation.
The key test is rhythm monitoring during symptoms.
A normal ECG between episodes does not exclude a rhythm problem.
Fainting, chest pain, exertional symptoms or a family history of sudden death are red flags.
SVT can often be cured with catheter ablation.
Most people are reassured after assessment.
Guidelines and sources
This page follows current UK and European guidance:
Van Gelder IC et al. 2024 ESC Guidelines for the management of atrial fibrillation. European Heart Journal 2024;45:3314-3414.
Brugada J et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. European Heart Journal 2020;41:655-720.
Zeppenfeld K et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal 2022;43:3997-4126.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about palpitations.
What causes heart palpitations?
Most commonly extra beats, caffeine, alcohol, stress, anxiety, poor sleep, fever or thyroid problems. Heart rhythm disorders such as SVT or atrial fibrillation are also causes, so persistent palpitations need checking.
Are heart palpitations dangerous?
Usually not. Most are benign. They are more concerning if they come with fainting, chest pain, breathlessness, occur on exertion, or if there is heart disease or a family history of sudden death.
What does a racing heart feel like?
A pounding or fast heartbeat, often felt in the chest, neck or throat. A fast regular rate that starts and stops suddenly suggests SVT, whereas a gradual change suggests a normal fast rhythm with anxiety, fever or exercise.
When should I worry about palpitations?
If they are accompanied by fainting, chest pain, severe breathlessness or happen on exercise, or if you have a family history of sudden death or known heart disease. Call 999 for collapse or severe chest pain.
What is the best test for palpitations?
Recording your heart rhythm during an episode, using a Holter, patch monitor, event recorder or loop recorder, along with an ECG, blood tests and often an echocardiogram.
Can anxiety cause palpitations?
Yes, anxiety can make the heart race and make you aware of normal beats. It is important to exclude a heart rhythm problem first, because the two can coexist, and anxiety is itself treatable.
Can caffeine or alcohol cause palpitations?
Yes. Both can trigger ectopic beats and, in some people, atrial fibrillation. Cutting down often helps.
Can palpitations be cured?
Many causes can. Triggers can be removed, SVT and flutter can usually be cured by ablation, and benign ectopics often settle with reassurance and reducing triggers.
Can my smartwatch diagnose palpitations?
It can record a useful rhythm strip and flag possible AF, but readings can be wrong, so show them to a doctor. A normal reading does not rule out a rhythm problem.
Can I have private monitoring for palpitations?
Yes. A telephone, video or face-to-face consultation in Peterborough or Corby can assess your symptoms, with nationwide cardiac monitoring, ECG reporting and echocardiography arranged as needed.
- What rhythm is causing my palpitations?
- Do I need rhythm monitoring, and which type?
- Do I need an echocardiogram or other tests?
- Could caffeine, alcohol, thyroid or anxiety be contributing?
- Do I need treatment, and what are the options?
- Could ablation cure it?
- Is it safe to exercise?
- What symptoms should make me seek urgent help?
What different rhythms look and feel like
Many people describe palpitations as a flutter, a pounding or a skipped beat. The pattern of the pulse, how it starts and stops, and how long it lasts all help your cardiologist work out which rhythm is responsible.
From palpitations to a diagnosis
Most palpitations are harmless, but recording the rhythm during an episode is the only reliable way to know the cause.
If you have palpitations, a racing heart or an irregular pulse, you may benefit from a telephone consultation or video consultation to discuss your symptoms in detail, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as ECG reporting, cardiac monitoring and echocardiography may be recommended.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.