Heart palpitations: causes, symptoms and treatment explained

Heart palpitations are quite common but are usually not anything serious, even though they can be disconcerting. 

Here we’ll discuss what you need to know about heart palpitations, including when to talk to your GP. 

What are heart palpitations?

Heart palpitations describe the feeling of being aware of your heart beating loudly. Your heart rate may become faster or slower than normal, or skip a beat.

While palpitations can cause concern, they are very common, usually stop on their own and in the majority of cases are not a sign that anything is wrong.

What are the symptoms of heart palpitations?

Your heart may feel as if it is pounding, fluttering or racing. You may feel this sensation in your chest, neck or throat, or if you’re lying down, in your ears.

Heart palpitations generally last for seconds or minutes but sometimes can last for hours at a time.

What causes heart palpitations?

There are several different triggers for heart palpitations, including:

• Certain medications
• Heart conditions
• Heart rhythm issues
• Hormone changes
• Your emotions
• Your lifestyle 

Emotional factors and heart palpitations

Emotional and psychological factors can trigger heart palpitations — stress, anxiety and panic attacks are common causes. Even getting overexcited or nervous can cause heart palpitations. 

In these cases, breathing exercises can help you push past the emotional triggers and stop your palpitations. It is also a good idea to deal with the issues causing your stress and anxiety so you can avoid further palpitations. 

Heart conditions and heart palpitations

Underlying heart conditions can cause palpitations in some cases. These include:

• Cardiomyopathy
• Congenital heart disease
• Heart attack
• Heart failure
• Heart valve problems (such as mitral valve prolapse)

If you have a heart condition and experience palpitations, you should see your GP.

Heart rhythm issues and heart palpitations

Palpitations can be caused by changes to your regular heartbeat called arrhythmia. 

There are several different types of arrhythmia, including:

• Atrial fibrillation — where the upper chambers of your heart beat rapidly and irregularly
• Atrial flutter — this begins in the upper chambers of your heat and usually causes your heart to beat rapidly
• Supraventricular tachycardia (SVT)— where your heart suddenly beats rapidly 
• Ventricular tachycardia — this begins in the lower chambers of your heart and causes your heart to beat rapidly

Hormone changes and heart palpitations

Changes in your hormone levels can cause heart palpitations, although they will usually go away on their own when your hormones stop fluctuating. 

Hormone changes can be caused by:

• Menopause
• Pregnancy
• Thyroid problems
• Your menstrual cycle

Lifestyle factors and heart palpitations

Lifestyle factors, such as lack of sleep, strenuous exercise and drinking caffeinated drinks, can cause heart palpitations. They can also be brought on by eating spicy or carbohydrate-rich foods, alcohol, smoking and illegal drug use.

Dehydration can also cause heart palpitations, so it is important to stay hydrated throughout the day, especially if you often experience palpitations.

If you notice that something in your lifestyle often triggers your heart palpitations, cutting it out can reduce your palpitations.

Medications and heart palpitations

Certain medications can trigger heart palpitations. However, you shouldn’t stop taking your medication without first speaking to your GP. Your GP may change your dose or prescribe you an alternative medication.

Medicines that can cause heart palpitations include: 

• Antibiotics
• Antidepressants
• Antifungal medications
• Antihistamines
• Asthma inhalers 
• Medications for high blood pressure

Other conditions and heart palpitations

Several other health conditions that can cause heart palpitations include:

• Anaemia
• Blood loss
• Fever
• Low blood sugar
• Low blood oxygen levels
• Sleep apnoea

When should you see a doctor about heart palpitations?

If you only get palpitations occasionally or they only last a short time, they are not usually a cause for concern. 

You should see your GP about heart palpitations if they last a long time, don’t improve or get worse over time. It is also a good idea to talk to your GP if you have a history of heart problems. 

In some cases, palpitations can be accompanied by other symptoms, which could be a sign of a more serious condition. These symptoms include:

• Blackouts or fainting
• Chest pain or chest tightness
• Confusion
• Dizziness
• Pain in your arms, chest, neck, jaw or upper back
• Severe shortness of breath or difficulty breathing

If your heart palpitations are accompanied by any of the above symptoms, you should seek emergency treatment. 

How are heart palpitations diagnosed?

Your GP will try to identify the cause of your heart palpitations. To help, keep a diary on what your palpitations feel like, when they happen and how long they last.

To reach a diagnosis, your GP will ask about your symptoms and medical history, and may perform a physical exam and in some cases, measure your heart rate and rhythm with an electrocardiogram (ECG). 

They may ask about lifestyle factors too, such as your:

• Alcohol intake
• Caffeine and stimulant use
• Physical activity levels
• Sleep patterns
• Stress levels
• Supplement use

If your GP thinks there could be an underlying heart condition causing your heart palpitations, they may refer you to a heart specialist called a cardiologist. Your cardiologist may run other tests to rule out a range of conditions. 

Tests can include blood tests to check your blood cell levels, hormone levels and electrolytes, as well as: 

• Cardiac CT scan to check the structure of your heart and blood vessels supplying it using a CT scanner and X-rays
• Chest X-ray to see if your heart is enlarged
• Coronary angiography to see how blood is flowing through your heart
• Echocardiogram to capture moving images of your heart using sound waves
• Electrophysiology — a study to check your heart’s electrical function
• Holter monitor — a machine you wear for a set amount of time (eg 24 hours) to record your heart rhythm

What is the treatment for heart palpitations?

In many cases, treatment is not needed for heart palpitations. If treatment is needed, it will depend on your symptoms, how often they occur and what is causing them.

If your palpitations are caused by your emotions, breathing techniques and other activities to help you stay calm can help. If your palpitations are caused by avoidable lifestyle factors, such as drinking too much caffeine or alcohol or using illegal drugs, your doctor will recommend avoiding these triggers. If medication is causing your palpitations, your doctor may be able to prescribe alternative medication.

If your GP thinks that medication is needed to reduce recurrent heart palpitations, they may prescribe antiarrhythmic drugs.

When arrhythmia is the cause of your palpitations, you may need to have a procedure, such as:

• Catheter ablation surgery — an ablation device is passed through your blood vessels and to your heart via a thin tube (catheter) to pinpoint the location of the tissue causing your arrhythmia so it can be destroyed
• Electrical cardioversion — sending an electrical shock into the chest to stabilise your heart rate and rhythm
• Pacemaker — a device is implanted into your chest to monitor and regulate the electrical activity of your heart

If you have regular palpitations with no identifiable cause, try to stay hydrated and remain calm when your palpitations start. Relaxing and deep breathing can help them dissipate faster. You may also want to discuss possible supplements that could help with your GP. 

You can also reduce your chances of experiencing heart palpitations by:

• Avoiding dips in your blood sugar levels
• Cutting down on caffeine
• Exercising regularly
• Maintaining a healthy, balanced diet
• Minimising how much alcohol you drink
• Quitting smoking