Heart palpitations

Heart palpitations are when you suddenly become more aware of your heartbeat. It might feel like your heart is racing, pounding, fluttering, or skipping a beat, and you may notice it in your chest, neck or throat.

What are heart palpitations?

Heart palpitations are when you suddenly become more aware of your heartbeat. It might feel like your heart is racing, pounding, fluttering, or skipping a beat, and you may notice it in your chest, neck or throat.

What causes heart palpitations?

Heart palpitations are common and not usually a sign of anything serious. Everyday triggers include:

• strenuous exercise
• stress, anxiety or panic
• lack of sleep
• alcohol, caffeine, nicotine or recreational drugs
• spicy or rich food
• some medicines, including asthma or COPD inhalers and decongestants; check the leaflet that comes with any medicine you're taking.

Hormonal changes can also cause palpitations, including during pregnancy or the menopause.

Sometimes an underlying medical condition is responsible, such as:

• iron deficiency anaemia
• an overactive thyroid
• low blood sugar, potassium or oxygen levels
• a heart rhythm problem (arrhythmia), such as atrial fibrillation
• other heart conditions, such as heart valve disease or cardiomyopathy.

Are there different types of heart palpitations?

Palpitations are categorised by the pattern of symptoms that you experience during these episodes:

• ectopic beats: an early or extra heartbeat, which is very common and usually harmless
• arrhythmia: a genuine problem with your heart's rhythm, such as atrial fibrillation, which does need to be assessed by a doctor
• palpitations with a normal heart rhythm: sometimes heart monitoring finds nothing unusual, even though the sensation you felt was real.

How are heart palpitations diagnosed?

Your doctor will ask about your medical history and your symptoms, including when the palpitations happen, how often, how long they last, what you're doing when they start, and what helps. They'll listen to your heart and lungs, and may ask you to tap out the rhythm you felt, since palpitations often aren't happening during your appointment.

Depending on what they suspect, tests might include:

• blood or urine tests, to check for thyroid problems, anaemia or an electrolyte imbalance
• an electrocardiogram (ECG), a painless test that checks the electrical activity of your heart
• a Holter monitor, a portable ECG device you wear for a day or more to record your heart's activity over time
• an echocardiogram (heart ultrasound), a stress test, or other specialist tests, if you're referred to a cardiologist or electrophysiologist (a heart rhythm specialist).

How are heart palpitations treated?

Many palpitations don't need any treatment once the cause is identified, especially if they're linked to lifestyle triggers rather than an underlying heart condition. These changes can help reduce how often they happen:

• cut back on or avoid caffeine, alcohol and nicotine
• keep a symptom diary to help you spot and avoid your personal triggers, such as certain foods
• manage stress through relaxation techniques, such as deep breathing, yoga, meditation or mindfulness
• exercise regularly, checking with your GP first about what's suitable for you
• keep your blood pressure and cholesterol under control.

If a medicine you're taking seems to be causing palpitations, speak to whoever prescribed it before you stop, since stopping some medicines suddenly can cause problems of its own.

If tests find an underlying heart condition, such as an arrhythmia, you may need:

• medicines, such as beta-blockers, to help control your heart rate and rhythm
• a procedure or a small device to correct the problem
• treatment for another underlying cause, such as thyroid medication if an overactive thyroid is responsible.

When should I see a doctor?

See a GP if you have palpitations and feel well, but:

• they keep coming back or are happening more often
• they last longer than a few minutes
• you have a heart condition, or a family history of heart problems
• you're worried about them.

Call 999 or go to A&E if you currently have palpitations that won't go away, or you also have:

• chest pain or tightness
• severe shortness of breath
• dizziness or light-headedness
• fainting, or feeling like you're about to faint.

If you've had these symptoms but they've now stopped, ask your GP surgery for an urgent appointment, or call 111.

Don't drive yourself to A&E; ask someone to drive you there, or call 999 for an ambulance. Take any medicines you're taking with you.