Palpitations

Summary

Palpitations are the sensation of the heart beating abnormally - irregularly, too fast or too hard, even when you’re at rest. This is often described as a feeling of fluttering, skipping a beat, pounding or racing, and may be felt in the chest, throat or neck. It can last for a few moments or a few hours; and can happen seldom, or every day.

Palpitations are common, and mostly not a sign of anything serious. However, they can be unpleasant, and can in some cases indicate a heart condition.

Other names

Irregular heartbeat, Heart pounding or racing, Arrhythmias

Possible causes

Palpitations are mostly no cause for concern. A speeded-up heartbeat may simply be the body’s natural response to exertion, stress or stimulation.

In some patients, however, palpitations may be caused by heart arrhythmias – heartbeats that are too slow, too rapid, irregular or premature – which may result from diseases or abnormalities of the heart muscle, valves, arteries or electrical system.

There are various other causes of palpitations, not related to heart disease:

• Certain drugs speed up the heart. These include stimulants like cocaine and amphetamines, but also asthma medications and decongestants, antihistamines, diet aids, thyroid pills, beta blockers and anti-arrhythmics.
• Caffeine, alcohol (including binge drinking) and smoking can also cause palpitations.
• Emotional states such as fear, stress, depression or anxiety affect the heartbeat. Panic attack, in particular, can make the heart pound.
• Physical exertion can speed up the heart excessively, especially when combined with fear or excitement. Hyperventilation also can cause palpitations.
• Palpitations are a common symptom of hyperthyroidism (overactive thyroid), as well as other medical conditions such as anaemia, hypoglycemia, low blood oxygen level and fever.

In some cases the cause of palpitations remains unknown.

When to see a doctor

Most palpitations are harmless, but your doctor should investigate if you have heart disease, or are at risk for it. Particularly, you should seek medical advice if you also experience shortness of breath, chest pain, sweating, dizziness, lightheadedness or faintness. If these symptoms are severe, call emergency services.

In general, consult your doctor if:

• The palpitations are frequent and bothersome
• You often experience extra heartbeats
• You are at risk for heart disease, for example if you have high cholesterol, high blood pressure or diabetes
• If you have never had palpitations before, or they feel different to before
• Your pulse (at rest) is more than 100 beats per minute

Your doctor will examine you and ask you about your diet, medication and existing conditions. You may have a blood test, or be given an electrocardiogram to measure your heartbeat. You will possibly need to wear a heart monitor for a short period. If there seems to be a heart problem, you will be referred to a cardiologist.

Treatment

Palpitations without underlying heart problems may not need treatment. Patients are advised simply to reduce stress, stop smoking and cut down on alcohol.

If there is a heart condition, a cardiologist will advise on care and treatment. For persistent palpitations, beta-blockers or other medications can reduce premature contractions.

Everybody should try to reduce risk factors for heart disease: don’t smoke, eat healthily, exercise regularly, manage stress, use caffeine and alcohol in moderation, and monitor your blood pressure and cholesterol.