Palpitations

Authored by , Reviewed by Dr Adrian Bonsall on | Certified by The Information Standard

Palpitations are the sensation of your heart beating and are common. Most cases are harmless. They usually only last for a short time and can be accompanied by other symptoms such as breathlessness, dizziness, chest tightness and a feeling of anxiety. Palpitations that are severe or don't settle quickly may need urgent medical attention. The most common causes are mentioned below.

What are heart palpitations?

Dr Yassir Javaid

Palpitations are rapid, thumping or fluttering feelings that people experience in their chest. They may be on the left-hand side or the middle of the chest. Normally we are not aware of our heart beating. The term 'palpitations' is used when we are aware of our heart beating. Some people say their heart feels like it's racing; others say their chest hurts, thumps or flutters. Usually this sensation is caused by a heart rate that is faster than usual for your age, gender and level of fitness. Occasionally, the feeling is due to an abnormal heart rhythm. See Anatomy of the heart for more information about the heart.

Occasionally, palpitations can be serious. In the following situations, you should call an ambulance:

  • If you have palpitations that do not go away quickly (within a few minutes).
  • If you have any chest pain with palpitations.
  • If you have severe breathlessness with palpitations.
  • If you pass out, or feel as if you are going to pass out, or feel dizzy.
  • If you have palpitations and have had heart problems in the past.
  • If you have palpitations which began as you were exercising.

If the palpitations do not make you feel unwell, and settle on their own, you should see your GP. Keep a diary of when they happen and how long they last, as this information will help your GP.

If you have an episode of palpitations it can be useful to check your pulse. In particular it may be useful for your doctor to know how fast your pulse was during the episode. That is, how many beats per minute; also, if your pulse felt regular or irregular. This information can help identify the cause of the palpitations. Your practice nurse can show you how to take your own pulse. Or you can follow the steps shown on the British Heart Foundation website, given in 'Further reading & references' at the end of this leaflet.

This list does not include all the possible causes of palpitations but lists some of the more common causes, including:

A fast but regular heartbeat (sinus tachycardia)

There are many reasons why the heart rate can be faster than normal. Some of these are:

A serious underlying abnormality of the heart is a rare cause of sinus tachycardia. Treatment will depend on the underlying reason for the fast heart rate.

Slow heart rate (bradycardia)

Read more about bradycardia.

Abnormal heart rhythms (arrhythmias)

Read more about abnormal heart rhythms (arrhythmias).

You are likely to be asked about your intake of the substances mentioned above and the circumstances in which the palpitations occur. Your doctor will take your pulse and blood pressure, listen to your heart and order further tests as appropriate. Initial investigations will include:

All these tests are to make sure there is no abnormality in your heart causing the palpitations. However in many cases, palpitations are NOT caused by any problem with your heart.

Treatment will depend on the likely cause of your palpitations. If, for example, your palpitations are caused by drinking too much caffeine, you will be advised to cut down how much caffeine you drink. If your palpitations are caused by anxiety, your GP will discuss ways of managing this.

Some cases of palpitations are managed by a GP; other cases may be referred to a heart specialist (cardiologist). In either case, the treatment you will be given depends on the cause that has been found.

Further reading and references

  • ; Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace. 2011 Jul13(7):920-34. doi: 10.1093/europace/eur130.

  • ; British Heart Foundation

  • ; American Heart Association, 2009

  • ; Cardiac arrhythmias--trials and tribulations. Lancet. 2012 Oct 27380(9852):1448-51. doi: 10.1016/S0140-6736(12)61773-5.

  • ; Targeting tachycardia: diagnostic tips and tools. J Fam Pract. 2012 May61(5):258-63.

  • ; Current trends in supraventricular tachycardia management. Ochsner J. 2014 Winter14(4):586-95.

  • ; The Future of Arrhythmias and Electrophysiology. Circulation. 2016 Jun 21133(25):2687-96. doi: 10.1161/CIRCULATIONAHA.116.023519.

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Philly89
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