palpitations screening test preparation

Overview

Palpitations are feelings that your heart is pounding, fluttering, or beating irregularly. To find out what’s causing them, your doctor may suggest a screening test like an electrocardiogram (ECG) or a Holter monitor. Preparing properly helps these tests get accurate results.

Yes, palpitations are extremely common. Most people will feel them at some point in their life, and in the vast majority of cases they are not a sign of serious heart disease.

Palpitations can affect anyone, but they happen more often in people who are stressed, anxious, or have conditions like anemia or an overactive thyroid. They also occur frequently during pregnancy.

Symptoms

Common symptoms

• A feeling that your heart is racing or pounding in your chest.
• A fluttering or flip-flop sensation in the chest.
• The sense that your heart has skipped a beat or is beating unevenly.
• Occasional mild dizziness or a feeling of being light-headed.

Symptoms in children

• Children may complain of a 'jumping' or 'fluttering' feeling in their chest.
• They might seem unusually tired or short of breath during play.
• Young children may not be able to describe the sensation; watch for clutching their chest or looking pale.

Symptoms in older adults

• Older adults may feel a more constant irregular heartbeat.
• They may also experience tightness in the chest, shortness of breath, or fainting spells along with the palpitations.
• Sometimes the heartbeat feels slow and heavy rather than fast.

Causes

Main causes

• Strong emotions like stress, anxiety, or excitement.
• Intense physical exercise or overexertion.
• Caffeine, alcohol, nicotine, and recreational drugs.
• Fever, dehydration, or low blood sugar.
• Anemia (low red blood cells) or thyroid gland problems.
• Heart rhythm disorders (arrhythmias), such as atrial fibrillation.

Risk factors

• Chronic anxiety or panic disorder.
• High blood pressure or a history of heart disease.
• Pregnancy (often harmless in pregnancy).
• Use of certain medications like decongestants or asthma inhalers.
• Electrolyte imbalances (low potassium or magnesium).
• Family history of heart rhythm problems.

When to see a doctor

See a doctor urgently if:

• If your palpitations come with chest pain, shortness of breath, or fainting—call 999 or your local emergency number immediately.
• If you have a known heart condition and palpitations change in frequency or feel different.

Book a routine appointment if:

• If you have palpitations that happen now and then and do not cause other symptoms, talk to your doctor at your next check-up.
• If the palpitations worry you or affect your daily life, make an appointment to discuss them.
• If you are starting a new medication and notice palpitations, ask your doctor or pharmacist.

Diagnosis

Your doctor will ask about your symptoms, health history, and do a physical exam. Then they may order one or more tests to record your heart’s electrical activity and check for underlying conditions.

Tests that may be done

• Electrocardiogram (ECG) – a quick, painless test that records your heart’s rhythm for a few seconds.
• Holter monitor – a small, portable device you wear for 24 to 48 hours that records all your heartbeats while you go about your day.
• Event monitor – a device you wear for weeks; you press a button when you feel symptoms to record that moment.
• Echocardiogram – an ultrasound that creates a moving picture of your heart to check its structure and function.
• Blood tests – check for anemia, thyroid problems, or electrolyte imbalances.

What to expect at your appointment

For an ECG, you will lie down and have sticky patches placed on your chest, arms, and legs. It is painless and takes about 5 minutes. For a Holter monitor, you will be fitted with the patches and a small recorder to wear in a pouch. You go home and keep a diary of your activities and any symptoms. Avoid getting the device wet (no showering or swimming), and stay away from strong magnets or metal detectors. For an event monitor, you will be shown how to press a button when you feel palpitations. The preparation is simple: wear loose, comfortable clothes (two-piece is best), do not apply lotions or powders to your chest, and avoid caffeine for at least a few hours before the test if your doctor advises.

Treatment

Treatment depends on the cause. Many palpitations need no treatment at all. If a condition like thyroid disease or anemia is found, treating that often stops the palpitations. If a heart rhythm disorder is responsible, your doctor may recommend lifestyle changes, medication, or a procedure to correct it.

Self-care at home

• Cut back on caffeine, alcohol, and nicotine.
• Practice relaxation techniques like deep breathing, meditation, or yoga to manage stress.
• Stay well hydrated and eat regular meals to avoid low blood sugar.
• Get enough sleep and avoid overexertion.
• Keep a symptom diary – note what you were doing when palpitations started – to share with your doctor.

Medical treatments

Your doctor may prescribe medicine to help control your heart rate or rhythm. These are chosen based on your specific condition. Do not take any heart medication without a prescription. For some arrhythmias, a procedure called catheter ablation may be recommended to fix the electrical pathway causing the problem. A pacemaker might be needed if your heart beats too slowly. Your cardiologist will explain the options and what is best for you.

When is surgery considered?

In very rare cases, if an underlying structural heart problem (like a faulty heart valve) is causing the palpitations, surgery on the heart may be needed. Your doctor will discuss this only if tests point to a problem that requires surgical repair.

Living with this condition

With simple lifestyle adjustments and, if needed, a treatment plan, most people with palpitations lead normal, active lives. If you have a heart condition, follow your doctor’s advice about regular check-ups and medications.

Lifestyle tips

• Learn to recognize and avoid your personal triggers (like certain drinks or stressful situations).
• Keep a diary of symptoms to help you and your doctor track patterns.
• Stay active, but check with your doctor if exercise tends to trigger palpitations.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains, and low in salt and unhealthy fats. Avoid very heavy meals. Regular moderate exercise like walking, swimming, or cycling is good for heart health – but if you notice palpitations during exercise, slow down and talk to your doctor before continuing.

Mental health and emotional wellbeing

Palpitations can cause anxiety and make you worry about your heart. It is normal to feel concerned, but most palpitations are harmless. If the worry becomes overwhelming, speak with a counsellor or your doctor. Practicing mindfulness or relaxation techniques can also help.

Prevention

Not all palpitations can be prevented, but you can lower your chances by managing triggers. Limit caffeine and alcohol, avoid smoking, stay hydrated, and reduce stress. Keeping your heart healthy with a good diet, exercise, and regular check-ups also helps.

Screening programmes

If you have risk factors for heart disease (like high blood pressure, diabetes, or family history), regular health check-ups can pick up problems early. If you already have palpitations, the screening tests described above can identify the cause quickly.

Complications

If left untreated

• If the palpitations are caused by a serious arrhythmia that is left untreated, it could increase your risk of stroke, heart failure, or, very rarely, cardiac arrest.
• However, most palpitations are benign and do not lead to complications.

Long-term outlook

The outlook is generally very good. Most people with palpitations do not have a serious heart condition, and the symptoms often go away on their own. When treatment is needed, it is very effective. With the right care, you can manage palpitations and continue with your daily life.

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