palpitations with fatigue

Overview

Palpitations with fatigue means feeling your own heartbeat (like it's racing, fluttering, or pounding) while also feeling very tired or low on energy. It can happen on its own or together, and it often has a harmless cause, but sometimes it points to an underlying health issue.

Yes, many people experience palpitations at some point, and tiredness is a very common symptom. Having both together is not rare.

It can affect people of any age, including children and older adults. It is more common in women, during pregnancy, or in people with anxiety, stress, or certain medical conditions.

Symptoms

Common symptoms

• Feeling like your heart is racing, pounding, fluttering, or skipping a beat.
• A sensation of a 'lump' in the throat or chest when your heart beats.
• Unexplained tiredness or low energy even after rest.
• Dizziness or feeling lightheaded.
• Shortness of breath with mild activity.

Symptoms in children

• Children might say their 'heart is beating fast' or feel 'tired all the time'.
• They may seem less active than usual or complain of chest discomfort.
• Sometimes they can't describe what they feel, so look for changes in play or sleep.

Symptoms in older adults

• Palpitations can feel less noticeable, but may come with chest pressure or shortness of breath.
• Fatigue can be more severe and easily mistaken for 'just getting older'.
• Fainting or near-fainting spells are more common in older adults with palpitations and fatigue.

Causes

Main causes

• Stress, anxiety, or panic attacks.
• Excessive caffeine, alcohol, or nicotine use.
• Dehydration or not eating enough.
• Anemia (low red blood cells).
• Overactive thyroid (hyperthyroidism).
• Low blood sugar or electrolyte imbalances.
• Certain heart rhythm disorders (like atrial fibrillation).
• Side effects of some medications or supplements.

Risk factors

• High levels of stress or anxiety.
• Poor sleep habits or sleep disorders.
• Smoking or heavy alcohol use.
• High blood pressure or heart disease.
• Family history of heart rhythm problems.
• Recent illness with fever or infection.

When to see a doctor

See a doctor urgently if:

• If you faint, have chest pain, or severe shortness of breath.
• If your heart feels like it's racing and doesn't slow down for more than a minute.

Book a routine appointment if:

• If palpitations with fatigue last for more than a few weeks without a clear cause.
• If you have other symptoms like dizziness, breathlessness, or weight changes.
• If you have a known heart condition and notice new or worse symptoms.

Diagnosis

Your doctor will ask about your symptoms, medical history, and lifestyle. They will check your pulse, listen to your heart and lungs, and may run tests to find the cause.

Tests that may be done

• Electrocardiogram (ECG) – records your heart's electrical activity.
• Holter monitor – a portable ECG device worn for 24–48 hours to catch irregular heartbeats.
• Blood tests – check for anemia, thyroid problems, or electrolyte imbalances.
• Echocardiogram – an ultrasound of your heart to look at structure and function.

What to expect at your appointment

Your doctor will want to know when palpitations happen, how long they last, and what makes them better or worse. You may be asked to keep a symptom diary.

Treatment

Treatment depends on the cause. If it's due to anxiety, stress, or lifestyle, simple changes often help. If an underlying condition is found, it will be treated specifically.

Self-care at home

• Reduce or avoid caffeine, alcohol, and nicotine.
• Practice stress management: deep breathing, meditation, or gentle yoga.
• Stay hydrated and eat regular meals to prevent low blood sugar.
• Get enough sleep and establish a consistent bedtime routine.

Medical treatments

Your doctor may recommend medications to treat an underlying condition, such as thyroid medicine, iron supplements for anemia, or heart rhythm medications. Some people benefit from beta-blockers to control palpitations, but these are prescribed only after full evaluation.

When is surgery considered?

Surgery is rarely needed. In a few cases, a procedure called catheter ablation may be used for certain heart rhythm disorders that do not respond to other treatments.

Living with this condition

Keep a diary of your symptoms, including what you were doing and feeling when palpitations started. This helps you and your doctor find patterns. Avoid known triggers.

Lifestyle tips

• Get regular, moderate exercise – check with your doctor first.
• Prioritise sleep and relaxation.
• Limit caffeine and alcohol.
• Stay connected with friends and family for emotional support.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains. Avoid skipping meals. Exercise like walking, swimming, or cycling can improve heart health and reduce stress, but start slowly and listen to your body.

Mental health and emotional wellbeing

Anxiety and worry can make palpitations worse. If you feel anxious about your heart, talk to your doctor – they can help. Mental health support, including therapy, can reduce both anxiety and palpitations.

Prevention

Not always, but you can lower your risk by managing stress, staying hydrated, avoiding triggers, and keeping up with regular health check-ups.

Screening programmes

Routine blood pressure and heart checks can catch problems early. If you have a family history of heart rhythm issues, mention it to your doctor.

Complications

If left untreated

• If the cause is an arrhythmia, it could lead to fainting, falls, or stroke.
• Long-term underlying conditions like thyroid problems or anemia may worsen.
• Chronic palpitations can increase anxiety and reduce quality of life.

Long-term outlook

For most people, palpitations with fatigue are not dangerous and improve with lifestyle changes or treatment of the underlying cause. Many people return to normal activities with proper care.

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