palpitations when to seek care

Overview

Palpitations are a feeling that your heart is pounding, fluttering, skipping a beat, or beating too fast or hard. You may feel this in your chest, throat, or neck. Most palpitations are harmless, but sometimes they can be a sign of a heart problem.

Yes. Many people experience palpitations at some point in their lives. They are one of the most common reasons for visiting a doctor.

Palpitations can happen to anyone, at any age. They are more common in people who feel anxious, are pregnant, have an overactive thyroid, or have an underlying heart condition.

Symptoms

Common symptoms

• A racing heartbeat
• A pounding feeling in the chest
• A fluttering or flip-flopping in the chest
• A sensation that your heart skipped a beat
• A strong pulse in the neck

Symptoms in children

• A child may report their heart is 'jumping' or 'racing'
• A child may become pale, sweaty, or unusually tired
• A child may complain of chest discomfort or shortness of breath

Symptoms in older adults

• In older adults, palpitations may be less noticeable or may feel like a slow, strong thump
• Older adults may also faint, feel dizzy, or fall without remembering a fast heartbeat
• They may feel short of breath or have chest pain with palpitations

Causes

Main causes

• Stress, anxiety, or panic attacks
• Caffeine, nicotine, or alcohol
• Dehydration or low potassium
• Lack of sleep or over-exercise
• Hormone changes (including pregnancy or menopause)
• Thyroid overactivity
• Anemia
• Certain heart conditions, like atrial fibrillation or heart valve problems

Risk factors

• High stress levels
• Heavy use of caffeine or energy drinks
• Smoking or vaping
• Excessive alcohol intake
• Use of some stimulant medicines or illicit drugs
• History of heart disease
• Electrolyte imbalances

When to see a doctor

See a doctor urgently if:

• Contact your doctor or a same-day clinic if you have new, persisting palpitations lasting more than a few minutes at a time.
• Seek same-day care if palpitations are accompanied by dizziness, confusion, or a feeling that you might pass out.
• If you have heart disease, have had a heart attack, or have a pacemaker, get medical advice on the same day.

Book a routine appointment if:

• Make a routine appointment if you have occasional palpitations that are concerning or happening more often.
• If you notice palpitations after starting a new medicine or changing your dose, tell your doctor.
• Talk to your doctor at your next visit if you simply want reassurance about a fluttering feeling you have noticed.

Diagnosis

To find out what is causing your palpitations, your doctor will start by asking about your symptoms, your health history, and any medicines you take. They will listen to your heart and check your pulse. Based on this, they may recommend some tests.

Tests that may be done

• Blood tests to check your thyroid, blood count, and electrolytes
• Electrocardiogram (ECG/EKG) to record your heart's electrical activity
• Holter monitor (portable ECG worn for 24 to 48 hours)
• Event monitor (a device you wear for up to a few weeks, pressing a button when you feel palpitations)
• Echocardiogram (ultrasound of the heart) to check heart structure and function

What to expect at your appointment

You may be asked to keep a diary of when palpitations happen, how long they last, and what you were doing or feeling at the time. This information helps your doctor connect your symptoms to any rhythm changes. Test results will be explained to you in plain language, and any worries you have will be discussed.

Treatment

Treatment for palpitations depends on the cause. If tests show no heart problem, you may only need reassurance and small lifestyle changes. If an underlying heart rhythm issue is found, your doctor will discuss safe options to control your symptoms and reduce risk.

Self-care at home

• Reduce or avoid caffeine, energy drinks, and stimulants.
• Stay well-hydrated, especially in hot weather or during exercise.
• Practice slow breathing or relaxation exercises when you feel anxious.
• Get enough sleep and avoid staying up very late.
• Limit alcohol and avoid smoking or vaping.

Medical treatments

Your doctor may suggest approaches such as treating an underlying condition (like an overactive thyroid or anemia), using a type of medicine called an anti-arrhythmic to help control your heart rhythm (exact medicines and doses are chosen by your heart doctor), or a procedure such as catheter ablation to correct an abnormal electrical pathway. Never start or stop any heart medicine without your doctor's guidance.

When is surgery considered?

Catheter ablation or other procedures are not surgery in the traditional sense, but in rare cases where palpitations are caused by structural heart disease, your specialist may discuss an operation. This is only considered if medications or other approaches are not suitable.

Living with this condition

Most people with harmless palpitations live a full, active life. You can learn to manage triggers and feel more in control by tracking your symptoms and practising calm breathing during episodes.

Lifestyle tips

• Keep a heart diary to notice patterns and triggers.
• Manage stress with mindfulness, yoga, or talking to a friend.
• Keep up regular physical activity, but stop and rest if you feel dizzy.
• Avoid overtraining and extreme dehydration.
• Stick to your follow-up appointments.

Diet and exercise

Eat a balanced diet rich in vegetables, fruits, whole grains, and lean protein. Be mindful with salty foods, especially if you have high blood pressure. Aim for moderate exercise like walking, swimming, or cycling for about 30 minutes most days, unless your doctor advises otherwise. If you feel palpitations during exercise and they are accompanied by breathlessness or chest tightness, stop and seek medical advice.

Mental health and emotional wellbeing

Feeling your heart race can be scary, and anxiety often makes palpitations worse. It is normal to worry. If persistent worry affects your daily life, consider speaking to a mental health professional or your doctor about support. You are not alone, and help is available.

Prevention

You can reduce your chances of palpitations by avoiding common triggers like caffeine, alcohol, smoking, and stress. Maintaining good sleep habits, staying hydrated, and treating conditions like high blood pressure or thyroid disease can also help.

Complications

If left untreated

• Some heart rhythm problems can raise your risk of blood clots, which may lead to a stroke.
• Rapid or irregular heart rhythms can reduce blood flow, causing dizziness or fainting.
• In rare cases, an untreated serious rhythm problem can lead to cardiac arrest.

Long-term outlook

The outlook for most people with palpitations is excellent. Many people need no treatment at all. With the right diagnosis and advice, even those with an underlying heart condition can usually manage their symptoms successfully and continue to live an active life.

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