Heart palpitations

Stress, exercise, medication or, rarely, a medical condition can trigger the feeling of your heart fluttering or pounding rapidly.

Heart palpitations (pal-pih-TAY-shuns) are feelings of having a fast-beating, fluttering or pounding heart. Stress, exercise, medication or, rarely, a medical condition can trigger them.

Although heart palpitations can be worrisome, they're usually harmless. In rare cases, they can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that might require treatment.

Heart palpitations can feel like your heart is:

• Skipping beats
• Fluttering rapidly
• Beating too fast
• Pounding
• Flip-flopping

You might feel heart palpitations in your throat or neck as well as your chest. They can occur when you're active or at rest.

When to see a doctor

Palpitations that are infrequent and last only a few seconds usually don't need to be evaluated. If you have a history of heart disease and have palpitations that occur frequently or worsen, talk to your doctor. He or she might suggest heart-monitoring tests to see if your palpitations are caused by a more serious heart problem.

Seek emergency medical attention if heart palpitations are accompanied by:

• Chest discomfort or pain
• Fainting
• Severe shortness of breath
• Severe dizziness

Often the cause of your heart palpitations can't be found. Common causes include:

• Strong emotional responses, such as stress, anxiety or panic attacks
• Depression
• Strenuous exercise
• Stimulants, including caffeine, nicotine, cocaine, amphetamines, and cold and cough medications that contain pseudoephedrine
• Fever
• Hormone changes associated with menstruation, pregnancy or menopause
• Too much or to little thyroid hormone

Occasionally heart palpitations can be a sign of a serious problem, such as an overactive thyroid gland (hyperthyroidism) or an abnormal heart rhythm (arrhythmia).

Heart rhythm changes (arrhythmias) might cause a very fast heart rate (tachycardia), an unusually slow heart rate (bradycardia), a normal heart rate that varies from the usual heart rhythm or combination of the three.

You might be at risk of developing palpitations if you:

• Are highly stressed
• Have an anxiety disorder or have regular panic attacks
• Are pregnant
• Take medicines that contain stimulants, such as some cold or asthma medications
• Have an overactive thyroid gland (hyperthyroidism)
• Have other heart problems, such as an arrhythmia, a heart defect, previous heart attack or previous heart surgery

Unless a heart condition is causing your heart palpitations, there's little risk of complications. For palpitations caused by a heart condition, possible complications include:

• Fainting. If your heart beats rapidly, your blood pressure can drop, causing you to faint. This might be more likely if you have a heart problem, such as congenital heart disease or certain valve problems.
• Cardiac arrest. Rarely, palpitations can be caused by life-threatening arrhythmias and can cause your heart to stop beating effectively.
• Stroke. If palpitations are due to a condition in which the upper chambers of the heart quiver instead of beating properly (atrial fibrillation), blood can pool and cause clots to form. If a clot breaks loose, it can block a brain artery, causing a stroke.
• Heart failure. This can result if your heart is pumping ineffectively for a prolonged period due to an arrhythmia, such as atrial fibrillation. Sometimes, controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.

Your doctor will listen to your heart using a stethoscope and ask questions about your medical history. He or she will also likely look for signs of medical conditions that can cause heart palpitations, such as a swollen thyroid gland.

If your doctor suspects that your palpitations are caused by an arrhythmia or other heart condition, tests might include:

• Electrocardiogram (ECG). In this noninvasive test, a technician places leads on your chest that record the electrical signals that make your heart beat.

  An ECG can help your doctor detect problems in your heartbeat and heart structure that could cause palpitations. The test will be done either while you rest or during exercise (stress electrocardiogram).

• Holter monitoring. You wear this portable device to record a continuous ECG, usually for 24 to 72 hours, while you keep a diary of when you feel palpitations. Holter monitoring is used to detect heart palpitations that aren't found during a regular ECG exam. Some personal devices, such as smart watches, offer ECG monitoring. Ask your doctor if this is an option for you.
• Event recording. If you don't have irregular heart rhythms while you wear a Holter monitor or if the events occur less than once weekly, your doctor might recommend an event recorder. This portable ECG device is intended to monitor your heart activity over a week to a few months. You wear it all day, but it records only at certain times for a few minutes at a time. You activate it by pushing a button when you have symptoms of a fast heart rate.
• Echocardiogram. This noninvasive exam creates a moving picture of your heart using sound waves. It can show blood flow and structure problems with your heart.

Unless your doctor finds that you have a heart condition, heart palpitations seldom require treatment. Instead, your doctor might recommend ways for you to avoid the triggers that cause your palpitations.

If your palpitations are caused by a condition, such as an arrhythmia, treatment will focus on correcting the condition.

The most appropriate way to treat palpitations at home is to avoid the triggers that cause your symptoms.

• Reduce stress. Try relaxation techniques, such as meditation, yoga or deep breathing.
• Avoid stimulants. Caffeine, nicotine, some cold medicines and energy drinks can make your heart beat quickly or irregularly.
• Avoid illegal drugs. Certain drugs, such as cocaine and amphetamines, can bring on heart palpitations.

If you have heart palpitations with severe shortness of breath, chest pain or fainting, seek emergency medical attention. If your palpitations are brief and there are no other worrisome signs or symptoms, make an appointment to see your doctor. Your doctor can help you find out if your palpitations are harmless or a symptom of a more serious heart condition.

Here's some information to help you get ready for your appointment:

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet or fast.

Make a list of:

• Your symptoms, including any that seem unrelated to heart palpitations, and when they began
• Key personal information, including family history of heart disease, arrhythmias, stroke, high blood pressure or diabetes, as well as major stresses or recent changes in your life
• All medications, vitamins and supplements you take, including doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For heart palpitations, basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes?
• What should I do if my symptoms return?
• What tests will I need?
• Do I need treatment and, if so, what?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Have your symptoms been continuous or occasional?
• Do your palpitations start and stop suddenly?
• Does it seem like your palpitations have a pattern, such as occurring the same time every day or during a certain activity?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Are you having other symptoms such as shortness of breath, chest pain, fainting, or dizziness when you have palpitations?
• Have you ever had heart rhythm problems before, such as atrial fibrillation?

What you can do in the meantime

Before your appointment, you can try to improve your symptoms by avoiding activities or stresses that might cause your palpitations. Some common triggers include:

• Anxiety or panic attacks
• Too much caffeine or alcohol
• Use of medications or supplements that contain stimulants, such as energy drinks or some cold medicines

Last Updated:

October 28th, 2021