Heart palpitations are heartbeats that suddenly become more noticeable. Sometimes palpitations can feel like the heart skips a beat, or it is pounding, fluttering, or beating irregularly.
A person may experience these sensations in the throat or the neck.
Heart palpitations can feel frightening, especially when people experience them for the first time. They may be nothing to worry about but can require medical attention in some cases and a doctor should assess them.
A heart palpitation happens when someone becomes aware of their heartbeat, which may feel too fast, slow, or irregular. The heart pumps blood automatically, so people may usually be unaware of individual beats.
This pumping allows the blood to circulate throughout the body, delivering oxygen and other essential components. The heart has four chambers attached with one-way valves.
A heartbeat is a pumping action that happens in two parts:
- Part 1: As blood collects in the upper two chambers, an electrical signal causes a contraction that pushes blood to the lower chambers.
- Part 2: One side of the heart pushes blood to the lungs, where it mixes with oxygen, and the other side circulates oxygenated blood around the body.
Below is an interactive animation of a typical heartbeat.
Explore the animation with your mouse pad or touchscreen.
The heart skipping a beat can be the result of several factors, including:
1. Lifestyle triggers
Strenuous exercise, dehydration, not getting enough sleep, or drinking too much caffeine or alcohol
Smoking tobacco and using illegal drugs such as cocaine or stimulants such as Sudafed can also cause the heart to skip a beat.
2. Psychological or emotional triggers
Strong emotions such as stress or anxiety can cause heart palpitations.
They may also occur during a panic attack. Other symptoms of a panic attack include:
- feeling weak or dizzy
- numbness in the extremities
- chest pain or tightness
- shortness of breath
Some medicines can trigger heart palpitations. These include:
- asthma medications
- medications for high blood pressure
- antifungal medicines
Anyone who has frequent heart palpitations and is taking medication should check the list of possible side effects on the label. A person will need to talk with a doctor before stopping any medication. Heart palpitations may be a harmless side effect, but it is best to check.
4. Hormone changes
Periods, pregnancy, and menopause can all cause hormonal changes, which may lead to heart palpitations.
An overactive thyroid can also cause heart palpitations.
Arrhythmias are changes in the usual pattern of electrical impulses from the heart, causing irregular heartbeats. Some arrhythmias are harmless, but others can be
The following are examples of arrhythmias:
- Atrial fibrillation: Can cause a fast, irregular heart rate and increase the risk of stroke.
- Bradycardia: A slow heart rate.
- Tachycardia: A fast heart rate.
- Supraventricular tachycardia: A rapid heartbeat that can cause dizziness.
- Ventricular tachycardia: A potentially serious condition that causes a fast, regular heart rhythm and is sometimes associated with dizziness or blackouts.
6. Heart conditions
In some cases, palpitations can indicate problems with the heart. Examples include:
- Mitral valve prolapse: Which causes blood to flow inefficiently through the heart.
- Heart failure: This happens when the heart cannot pump blood effectively, and heart chambers can dilate.
- Hypertrophic cardiomyopathy: Refers to an enlargement of the heart muscle and its walls.
- Congenital heart disease: Refers to abnormalities that are present from birth.
7. Other medical conditions
The following issues can also cause palpitations:
- hypoglycemia, which refers to low blood sugar levels
- low blood pressure
- thyroid storm
- electrolyte abnormalities
Heart palpitations tend to feel like a fluttering or pounding in the chest or neck, or can feel like an irregular sensation in the chest.
When more serious arrhythmias are responsible, palpitations can occur with the following symptoms:
- shortness of breath or difficulty breathing
- chest pain or tightness
A person will need immediate medical attention if they experience these symptoms alongside heart palpitations. In extreme cases, heart palpitations can lead to sudden cardiac arrest.
If heart palpitations happen rarely, last less than 30 seconds, and pass quickly, a person can closely monitor them.
It is a good idea to speak with a doctor when palpitations:
- follow a history of heart problems
- last for long periods
- do not improve over time
- get worse
- are associated with symptoms such as dizziness, near fainting, fainting, chest pain, or shortness of breath
Some cases require emergency medical attention. A person should seek medical help immediately when palpitations accompany any of these symptoms:
- severe shortness of breath
- pain or tightness in the chest
- lightheadedness or dizziness
- fainting or blacking out
To investigate the cause of heart palpitations, a doctor will usually ask about a person’s symptoms and medical history. They may also recommend blood tests and an electrocardiogram (ECG) to check the heartbeat.
An ECG is a simple test to check the heart’s electrical activity. A doctor will place small electrodes onto the body that connect to an ECG machine with wires. This test can help a doctor see how the heart is functioning.
If the doctor suspects a heart problem or an arrhythmia, they may request:
Also called a continuous ambulatory electrocardiographic monitor, this is when a person wears a Holter monitor for 24–48 hours or up to 14 days to record the heart’s rhythm.
Learn more about Holter monitoring here.
Exercise or stress tests may trigger a palpitation so that a doctor can diagnose it. A person will usually walk and run on a treadmill or ride a stationary bicycle while a doctor monitors heart rate and rhythm.
Learn more about treadmill testing here.
An echocardiogram is an ultrasound that uses sound waves to create an image of the heart’s size, structure, and motions.
The sound waves echo off the heart, which a doctor can interpret through a computer to see images of the heart structure and valves.
An echocardiogram is a painless procedure similar to a pregnancy ultrasound.
A chest X-ray is another diagnostic tool doctors may use to check how the heart works. A chest X-ray can show the heart structure and any changes to the lungs that may result from a heart problem.
An X-ray is a painless procedure in which the X-ray passes over the chest area.
A doctor can use various blood tests to help diagnose heart palpitations, including:
- Full blood count (FBC): This test measures the levels of different parts of the blood, such as red blood cells. It can show if a person has an infection or disorder such as anemia, which can cause heart palpitations.
- Thyroid function tests: This test shows if a person’s thyroid gland is making abnormal levels of the hormone thyroxine. Abnormal levels are associated with heart palpitations.
- Urea and Electrolytes (Us and Es): This test measures important chemicals found in the blood, including electrolytes such as potassium and sodium. These help to stabilize heart rhythm.
A blood test involves a doctor taking a small sample of blood for testing in a laboratory. A medical professional inserts a needle into a person’s vein through the skin to collect the blood. The person may feel a slight sharp pricking sensation, but the procedure is not typically painful.
Treatment will depend on the cause of the palpitations. When lifestyle factors such as excessive alcohol or caffeine consumption are responsible, a person can take steps to avoid those triggers.
People with palpitations due to stress, anxiety, or panic attacks may benefit from learning breathing exercises and stress-management techniques, such as yoga and meditation. It may also be a good idea to speak with a therapist.
Some arrhythmias are harmless and do not require treatment. However, others may be clinically significant and require long-term medication.
A person with a diagnosed heart condition, such as heart failure, will usually need to follow a treatment plan that includes lifestyle changes and medication.
While not everyone with a congenital heart defect will need treatment, some may require surgery or cardiac catheterization.
Lifestyle changes such as eating a healthy, balanced diet
- a range of fruit and vegetables
- whole grains
- legumes, nuts, and seeds
- fish and seafood
In addition, people can minimize or avoid:
- processed or fried foods
- added sugars
- excess salt
- red meat
Keeping physically active, maintaining a healthy weight, and controlling blood pressure and cholesterol are important factors in managing heart conditions.
Other treatment options can include:
- a pacemaker — a device that stimulates a regular heartbeat
- an implantable cardiac defibrillator — a device that monitors and corrects an irregular heart rhythm
- mild electrical shock — a procedure to return the heart to its usual rhythm
- heart surgery to remove any section of the heart that is not functioning as expected
Heart palpitations are a common condition and typically not a cause for concern. However, sometimes a more serious condition causes them and they require medical attention.
Causes of heart palpitations include lifestyle triggers such as drinking alcohol, smoking, taking illegal drugs, not getting enough sleep, and strenuous exercise. They may also occur due to psychological triggers, hormonal changes, and certain medications.
Some palpitations may indicate an underlying heart condition such as an arrhythmia or heart failure. A person should speak with a medical professional immediately if they experience shortness of breath, pain or tightness in the chest, or blacking out.