Palpitations

What are palpitations?

Palpitations mean you notice your heartbeat more than usual. You may feel a flutter, thump, racing pulse, or a pause followed by a stronger beat. The feeling can occur in your chest, neck or throat, at rest or with activity.

Palpitations are a symptom, not a diagnosis. Many have a harmless explanation, but the sensation alone cannot tell us which rhythm is present. The goal of testing is to connect what you feel with what your heart is doing.

When to seek care

A new racing heartbeat that will not settle needs prompt assessment. Arrange a visit for episodes that recur, last longer or become more frequent, even if you otherwise feel well. Tell your clinician about known heart disease or a family history of serious rhythm problems or unexplained sudden death.

What can cause them?

• Everyday triggers: poor sleep, stress, exertion, nicotine, alcohol or excessive caffeine. Energy drinks, stimulant supplements and some cold medicines can also contribute.
• Other health conditions: anemia, thyroid problems, fever or changes in electrolytes may affect the heartbeat. Pregnancy and menopause can be associated with palpitations too.
• Early beats: PACs start in the upper heart chambers; PVCs start in the lower chambers. The pause and stronger beat afterward may feel like a skipped beat. Occasional early beats are common; their frequency and the condition of the heart matter.
• A rhythm problem: examples include atrial fibrillation (AFib) and supraventricular tachycardia (SVT). SVT is a fast rhythm arising above the lower heart chambers; episodes may begin and end abruptly.

Stress can contribute, but new symptoms should not automatically be attributed to anxiety. Sources and further reading.

What happens at the first visit?

Your clinician will ask how often episodes happen, how long they last, whether they start and stop suddenly, and whether they occur during exercise or rest. They will ask about associated symptoms, your medical and family history, and medicines or supplements. An examination and an ECG are common starting points.

Bring a short symptom record and your medication list, including nonprescription products. Testing is chosen to answer your particular question; not everyone needs every test below.

Which tests might I need?

NHLBI: how rhythm problems are diagnosed.

What should I expect from a heart monitor?

If symptoms happen daily, a shorter recording may capture them. If episodes are less frequent, a longer patch or event-monitor recording may be more useful. Some patches record for up to two weeks; other devices record longer. Rare but concerning events may call for a different approach, such as an implantable loop recorder, after discussion with a specialist.

Follow the instructions for your exact device, including showering, activity and returning it. Note the time of symptoms and what you were doing; press an event button if instructed. Ask about adhesive irritation and whom to contact if the device comes loose.

Ask when and how you will receive results. Some monitors are analyzed after return. Do not assume your device is watched continuously or that pressing its button requests emergency help. See the rhythm-monitor guide.

What if the results are normal?

A normal ECG or monitor result is useful information, but ask whether your usual symptoms occurred during the recording. A recording without an episode may not answer the original question. Your clinician may consider a different monitoring period if symptoms continue.

If your usual symptoms were recorded during a normal rhythm, that is helpful and often reassuring. If early beats or another rhythm were found, their amount, duration, symptoms and heart structure help determine the next step.

If you already have a watch or handheld ECG, ask whether sharing a saved tracing would help. An automated alert alone does not establish AFib; the ECG signal needs clinician review. Do not delay urgent care to capture a recording. AF diagnosis guidance.

What helps, and will I need treatment?

Care depends on the cause. Some people need reassurance and follow-up; others need treatment for a contributing condition or rhythm problem. For troublesome early beats, a clinician may consider medication. Selected rhythm problems may benefit from an electrophysiology consultation or catheter ablation, but a procedure is not the usual starting point.

Prioritize sleep, avoid nicotine and stimulant drugs, and notice whether caffeine or alcohol tracks with symptoms. Discuss reducing a suspected trigger. Stay hydrated within any fluid limits your clinician has given you. Do not stop prescribed medicines or start potassium or magnesium supplements on your own.

Keep a brief record of the time, duration, activity and accompanying symptoms. If activity brings on symptoms, stop and ask about evaluation before increasing intensity. Agree on how to share your record, when results will be reviewed, and what changes should prompt a call.

Questions for your next visit

• What is the most likely explanation for my symptoms?
• Which monitor and recording duration fit how often my episodes happen?
• Do I need blood tests, an echo or an exercise test, and why?
• Were my usual symptoms captured, and what rhythm occurred at that time?
• Are any medicines, supplements or activities contributing?
• When will we review results, and what should I do if symptoms return?

Keep reading

• Your Zio or Rhythm Monitor
• Your Echocardiogram
• Atrial Fibrillation (AFib)