palpitations that comes and goes

Overview

Palpitations that come and go are feelings that your heart is pounding, fluttering, racing, or skipping a beat. They last for a short time and then stop on their own. Most of the time, they are not dangerous, but they can be unsettling.

Yes, almost everyone experiences occasional palpitations at some point in their life.

They can affect people of all ages, but are more common in young adults and people who are anxious or under stress.

Symptoms

Common symptoms

• A feeling that your heart is racing, pounding, or fluttering in your chest
• A sensation that your heart has skipped a beat or is beating irregularly
• A feeling of a 'thump' or strong beat in your chest or throat
• These sensations come and go, lasting from a few seconds to a few minutes

Symptoms in children

• Children may describe a 'flip-flop' or 'funny' feeling in their chest
• They might become pale or seem unusually tired during an episode
• Sometimes children say their heart is 'racing' or 'jumping'

Symptoms in older adults

• Palpitations in older adults can feel the same, but may be more likely to happen during physical activity
• They might also feel short of breath or lightheaded during an episode
• Older adults may have additional symptoms like chest pressure or unusual fatigue

Causes

Main causes

• Emotional stress, anxiety, or panic attacks
• Caffeine, alcohol, nicotine, or recreational drugs (like cocaine)
• Strenuous exercise or dehydration
• Hormonal changes, such as during pregnancy or menopause
• Certain medications, including some cold and asthma treatments
• Underlying heart conditions, such as atrial fibrillation (an irregular heart rhythm)

Risk factors

• High levels of stress or anxiety
• Drinking too much caffeine or alcohol
• Not getting enough sleep
• Having an overactive thyroid (hyperthyroidism)
• Having a family history of heart rhythm problems
• Being pregnant

When to see a doctor

See a doctor urgently if:

• If your palpitations are very frequent (several times a day) or last longer than usual
• If you have heart disease or a known heart rhythm condition and notice any change
• If you feel dizzy, lightheaded, or short of breath along with the palpitations
• If you have had a previous heart attack or stroke

Book a routine appointment if:

• If you are worried about your palpitations, even if they are mild and come and go
• If they are happening more often or bothering your daily life
• If you have other health conditions like diabetes or high blood pressure

Diagnosis

Your doctor will ask about your symptoms, medical history, and any triggers. They will listen to your heart and may check your pulse. Because the palpitations come and go, they might need to record your heart rhythm over time.

Tests that may be done

• Electrocardiogram (ECG or EKG) – a quick test that records your heart's electrical activity. It is often done in the clinic.
• Holter monitor – a portable ECG you wear for 24 to 48 hours to catch palpitations that happen during your normal day.
• Event recorder – a device you use for a few weeks. You press a button when you feel a palpitation to record your heart rhythm at that moment.
• Blood tests – to check for thyroid problems, anaemia (low iron), or other conditions that can cause palpitations.
• Echocardiogram – an ultrasound of your heart if the doctor suspects a structural problem.

What to expect at your appointment

If your doctor suspects a serious heart rhythm problem, they may refer you to a cardiologist (heart specialist). Most people with occasional, harmless palpitations do not need further tests beyond a simple ECG.

Treatment

Treatment depends on the cause. Many people with harmless palpitations do not need any treatment other than avoiding triggers. If an underlying condition is found, treatment will focus on that.

Self-care at home

• Try to identify and avoid triggers like too much caffeine, alcohol, or stress
• Practice relaxation techniques such as deep breathing or meditation
• Make sure you get enough sleep and stay hydrated
• If you smoke, consider quitting – smoking can make palpitations worse

Medical treatments

If palpitations are caused by an underlying heart rhythm problem, your doctor might recommend medicines to help control your heart rate or rhythm (for example, beta blockers or calcium channel blockers – always take as prescribed). In some cases, a procedure called catheter ablation (using heat or cold to fix the abnormal electrical pathway) may be offered. For people with atrial fibrillation, blood-thinning medicines may be needed to prevent stroke. Your doctor will explain the options and risks based on your specific situation.

When is surgery considered?

Catheter ablation is a procedure that can permanently fix some heart rhythm problems. It is not surgery in the traditional sense but is done through a thin tube inserted in a blood vessel. Open heart surgery is rarely needed for palpitations alone.

Living with this condition

Most people can live normally with occasional palpitations. Keeping a simple diary of when they happen and what you were doing can help you and your doctor understand the pattern.

Lifestyle tips

• Limit caffeine and alcohol – see if reducing them helps
• Learn stress management techniques like yoga or mindfulness
• Avoid stimulant drugs (including some over-the-counter decongestants)
• Get regular, moderate exercise – but listen to your body and rest if you feel unusually tired

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean protein supports overall heart health. Stay hydrated, as dehydration can trigger palpitations. Moderate exercise is generally safe, but if you notice palpitations during exercise, talk to your doctor first.

Mental health and emotional wellbeing

Palpitations can be worrying and may cause anxiety, which in turn can make them worse. It is a cycle. Talking to your doctor or a counsellor can help. Remember that in most cases, they are not dangerous.

Prevention

You cannot always prevent palpitations, but you can reduce how often they happen by avoiding known triggers, managing stress, and keeping healthy habits.

Screening programmes

Routine screening for palpitations is not needed for everyone. If you have risk factors like a family history of heart rhythm problems, your doctor may suggest periodic check-ups.

Complications

If left untreated

• Most people with harmless palpitations have no complications.
• If the palpitations are caused by a serious heart rhythm problem (like atrial fibrillation), untreated it can increase the risk of stroke or heart failure.
• Frequent, rapid palpitations may weaken the heart muscle over time (a condition called cardiomyopathy).

Long-term outlook

For the vast majority of people, palpitations that come and go are not dangerous and do not lead to complications. Even when a heart rhythm problem is found, treatments are very effective and most people can lead a normal, active life. With proper medical guidance, you can manage your symptoms and stay healthy.

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