Palpitations

Palpitations describe the sensation of being aware of your heart beating loudly in your chest, although you may also feel this sensation in your neck or throat. Your heart rate may vary during your palpitations, becoming faster or slower than normal or skipping a beat. 

It can be bothersome or cause you concern. However, it’s very common and for most people, there’s nothing to worry about. It can happen when you’re pregnant. But there are also many everyday causes, such as: 

• Doing something strenuous
• Drinking a lot of caffeine in a short period of time
• Drinking alcohol 
• Getting anxious or excited
• Smoking nicotine

Sometimes there doesn’t seem to be any cause and your palpitations quickly pass with no ill effects.

However, for some people, palpitations can be a sign of a heart problem or disease and should be checked out. Palpitations can be diagnosed with a test called ambulatory arrhythmia monitoring — this can help determine whether your palpitations are harmless or have an underlying medical cause. 

Palpitations can feel like some or all of the following:

• Extra (ectopic) beats, sometimes followed by a longer pause
• Faster or slower beats than usual
• Fluttering or pounding in your chest
• Missed beats

These sensations will usually pass in a few moments.

Ectopic beats are usually caused by your heart's natural pacemaker (the sinus node) releasing an electrical signal too early. This causes a short pause in your heartbeat, which feels like a missed beat before an extra beat occurs. There are two common types of ectopic beats: 

• Premature atrial contraction (PAC) — when the early electrical signal occurs in the upper chambers of your heart (atria)  
• Premature ventricular contraction (PVC) — when the early electrical signal occurs in the lower chambers of your heart (ventricles)  

If your palpitations are a sign of something more serious, you’ll usually have other symptoms, like feeling breathless or dizzy.

You should seek urgent medical attention if your symptoms suddenly become worse or you have any of the following symptoms: 

• Confusion or dizziness 
• Excessive sweating
• Loss of consciousness or fainting 
• Pain or pressure in your chest, arms, jaw, neck or upper back
• Shortness of breath
• Weakness

See your GP if: 

• Palpitations happen more, get worse or last a long time
• You have a history of heart problems
• Your palpitations occur when your resting heart rate is 100 beats per minute or more
• You’re worried about your heart palpitations

In most cases, palpitations are not serious but in rare cases, they may be a sign of a serious heart condition.

Your GP will ask about your medical history, diet, lifestyle and any medications or supplements you’re taking. They will also ask how often your palpitations occur, what you’re doing when they occur and how long they last. 

They will physically examine you and may suggest further tests to help identify the cause of your palpitations. These tests may include: 

• Blood tests
• Chest X-ray to check for lung changes caused by heart problems eg fluid in your lungs may be caused by heart failure
• Echocardiogram — an ultrasound scan of your heart to check its structure and function  
• ECG (electrocardiogram) to check your heart rhythm at rest and when exercising (stress ECG)
• Event recording to record your heart's electrical activity when your symptoms occur — you will wear a monitor on your chest and be given a handheld gadget
• Holter monitoring to record your heart's electrical activity for 24–48 hours — you will wear a monitor on your chest that continuously records your heart's activity; this can help pick up rhythm differences that weren't found during your ECG

If needed, your GP will refer you to a cardiologist (a doctor specialising in treating the cardiovascular system) for further tests or treatment.

Palpitations happen because of a blip in your heart’s natural pacemaker, which sends electrical signals to make your heart beat with a steady rhythm. There are a variety of different causes for palpitations, including: 

Emotional causes

Strong emotions, such as anxiety, fear, shock, stress or excitement can cause palpitations. You may therefore have palpitations during a panic attack, alongside other symptoms including nausea, sweating and trembling.

Lifestyle causes

• Alcohol, caffeine and recreational drugs (eg amphetamines, cannabis, cocaine, ecstasy and heroin)
• Certain herbal and nutritional supplements
• Poor sleep
• Smoking tobacco ie in reaction to nicotine
• Vigorous physical activity

Certain medications

• Asthma inhalers 
• Certain drugs used to prevent heart arrhythmias 
• Certain drugs used to treat an underactive thyroid
• Decongestants
• Diet pills

Diet

You may have palpitations after eating a heavy meal rich in carbohydrates, fat or sugar, or after eating a meal high in nitrates or sodium.

You may also have palpitations after eating because of a food sensitivity. Keep a food diary to record what you eat and when you have palpitations — this will help you identify food triggers for your palpitations so you can then avoid them. However, it is important not to completely exclude an entire food group from your diet (eg fruits, vegetables, carbohydrates, protein, dairy or fat). If you are unsure how to adapt your diet to avoid palpitations, speak to your GP or a dietitian.

Dehydration can also trigger heart palpitations.

Hormonal changes

In women, normal hormonal changes can cause palpitations ie just before menopause, during menstruation and pregnancy. Palpitations during pregnancy may be a sign of anaemia; you should therefore speak to your midwife or doctor about your symptoms. 

Heart rhythm problems

• Atrial fibrillation — this is the most common type of heart rhythm problem; it occurs when the heart beats irregularly and faster than normal 
• Atrial flutter — a fast but regular heartbeat 
• Supraventricular tachycardia (SVT) — an abnormally fast heart rate
• Ventricular tachycardia — an abnormal heart rhythm that is regular but fast; it is a serious condition that may cause blackouts or dizziness

Heart conditions

• Congenital heart disease — birth defects that prevent the heart from working properly
• Coronary artery disease
• Heart failure — when your heart can't pump blood around your body properly
• Heart muscle problems eg hypertrophic cardiomyopathy, where your heart muscle walls become enlarged and thickened
• Heart valve problems eg mitral valve prolapse
• Previous heart attack

These conditions often need treatment. 

Other medical conditions 

• Abnormal electrolyte levels (levels of salts and minerals that your body needs to work properly)
• Anaemia or blood loss
• Fever
• Hypoglycaemia — this commonly occurs in people with diabetes
• Low blood pressure and dizziness caused by changing positions eg from sitting to standing — known as postural or orthostatic hypotension  
• Thyroid disease or an overactive thyroid (hyperthyroidism)

Usually, palpitations won’t require any treatment. However, if they’re due to a medical condition, then your doctor will recommend appropriate treatment. If they are due to a certain medication you’re taking, your doctor will recommend an alternative treatment, if available and appropriate.

If your heart palpitations are caused by an arrhythmia, they may prescribe medication or surgery. They may also refer you to an electrophysiologist (someone who specialises in understanding heart rhythms).

If a cause can't be found, your doctor may advise you to avoid situations and things that are suspected to trigger your palpitations. If lifestyle changes don’t help, you may then be prescribed medications, such as beta-blockers or calcium channel blockers.

Easing heart palpitations caused by anxiety and stress

Try to avoid stressful situations and stay calm by practising relaxation techniques and exercises, such as tai chi or yoga. You may also want to try biofeedback therapy, guided imagery (mindfulness) or aromatherapy to ease your stress levels. 

Easing heart palpitations caused by diet

Avoid dietary triggers of palpitations, such as: 

• Alcohol 
• Caffeine
• Illegal drugs 
• Nicotine 

Avoid medications that act as stimulants

Avoid cough and cold medicines and certain herbal and nutritional supplements. If you’re unsure whether any supplements you’re taking are causing your palpitations, speak to your GP.