heart that comes and goes

Overview

A 'heart that comes and goes' usually means symptoms like a racing heart, skipped beats, or fluttering feelings that start and stop on their own. These symptoms may last a few seconds or several minutes. They can happen at any time, even when you are resting. In some cases, it can also mean chest discomfort that comes and goes, often brought on by activity and relieved by rest.

Yes, many people experience occasional palpitations or irregular heartbeats. They are very common and usually harmless, but a doctor should rule out more serious causes.

Intermittent heart symptoms can affect people of any age, including children and older adults. They may be more common in women, especially during hormonal changes, and in people with anxiety or stress.

Symptoms

Common symptoms

• A fluttering or pounding feeling in the chest (palpitations)
• A sensation that your heart is skipping a beat or beating too fast
• Chest discomfort that comes and goes, often with activity
• Dizziness or lightheadedness
• Shortness of breath

Symptoms in children

• Children may describe their heart feeling like it is 'flip-flopping' or racing.
• They might become unusually pale or complain of chest pain.
• Some children may feel tired or have trouble keeping up with play.

Symptoms in older adults

• Older adults may feel palpitations along with shortness of breath or fatigue.
• Chest discomfort that comes and goes is a classic symptom of angina (reduced blood flow to the heart).
• Dizziness or fainting can be a sign of a heart rhythm problem that needs prompt attention.

Causes

Main causes

• Stress, anxiety, or panic attacks
• Caffeine, alcohol, or nicotine
• Dehydration or electrolyte imbalances
• Hormonal changes (such as during pregnancy or menopause)
• Heart conditions like atrial fibrillation (a type of irregular heartbeat) or coronary artery disease

Risk factors

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking
• Family history of heart disease
• Age (risk increases with age)

When to see a doctor

See a doctor urgently if:

• See a doctor within 24 hours if you have chest discomfort, palpitations, or fainting.
• If you have known heart disease and notice new or worsening symptoms.

Book a routine appointment if:

• Make an appointment for a check-up if you have occasional palpitations or a fluttering feeling.
• If you have risk factors for heart disease and have never been screened.

Diagnosis

Your doctor will start by asking about your symptoms and your medical history. They will check your heart rate and rhythm, and may order tests to see what is happening.

Tests that may be done

• Electrocardiogram (ECG or EKG) — a test that records the electrical activity of your heart
• Holter monitor — a portable ECG device you wear for 24 to 48 hours to capture irregular heartbeats
• Event monitor — a device you wear for longer periods to record symptoms when they happen
• Blood tests to check for thyroid problems, anemia, or electrolyte imbalances
• Echocardiogram (ultrasound of the heart) to see how well your heart is working

What to expect at your appointment

You may be asked to keep a diary of your symptoms, noting when they happen, what you were doing, and how long they last. Most tests are painless and non-invasive. Your doctor will explain the results and what they mean for your health.

Treatment

Treatment depends on what is causing your symptoms. If an underlying heart condition is found, treatment aims to control the rhythm, prevent complications, and manage risk factors.

Self-care at home

• Reduce or avoid triggers like caffeine, alcohol, and smoking.
• Practice stress management techniques such as deep breathing, meditation, or yoga.
• Stay well-hydrated and maintain a balanced diet.
• Get regular, moderate exercise as recommended by your doctor.
• Keep a symptom diary to help your doctor identify patterns.

Medical treatments

Your doctor may prescribe medications to control heart rate or rhythm, or to prevent blood clots if you have a condition like atrial fibrillation. Other treatments include cardioversion (an electric shock to restore normal rhythm) or catheter ablation (a procedure to destroy the small area of heart tissue causing the problem). Always follow your doctor's advice and do not stop medications without talking to them first.

When is surgery considered?

In some cases, if medications are not effective or if there is a structural problem, surgery such as implanting a pacemaker or a defibrillator may be recommended. Your doctor will discuss the options with you.

Living with this condition

Many people with intermittent heart symptoms live full, active lives. The key is to work with your healthcare team to manage your condition and reduce your risk.

Lifestyle tips

• Eat a heart-healthy diet low in saturated fat, salt, and added sugars.
• Stay physically active with activities like walking, swimming, or cycling.
• Maintain a healthy weight.
• Avoid smoking and limit alcohol.
• Get enough sleep and manage stress.

Diet and exercise

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins supports heart health. Regular exercise, such as 30 minutes of moderate activity most days, can improve cardiovascular fitness. Always check with your doctor before starting a new exercise program.

Mental health and emotional wellbeing

Dealing with unpredictable heart symptoms can cause anxiety and worry. It is normal to feel concerned. Talk to your doctor if anxiety affects your daily life. Counseling or support groups can be helpful.

Prevention

Not all cases can be prevented, especially if there is a genetic cause. However, you can reduce your risk by adopting a heart-healthy lifestyle and managing conditions like high blood pressure, diabetes, and high cholesterol.

Screening programmes

Regular check-ups with your doctor can help identify risk factors early. If you have a family history of heart disease or sudden cardiac death, you may need earlier or more frequent screening.

Complications

If left untreated

• If an underlying heart rhythm problem is left untreated, it can increase the risk of stroke, heart failure, or cardiac arrest.
• Persistent fast heart rate can weaken the heart muscle over time.
• Angina that comes and goes can progress to a heart attack if the underlying artery narrowing worsens.

Long-term outlook

For most people, intermittent heart symptoms can be managed successfully with lifestyle changes and medical care. The outlook is generally good, especially when the cause is something simple like stress or caffeine. Even for more serious conditions, modern treatments are very effective. With proper management, you can continue to live a full and active life.

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