Palpitations and irregular heartbeat
Palpitations means feeling your heartbeat more than usual. Most of the time they are harmless, but sometimes they point to a rhythm problem. This page explains causes, checks and the signs that are urgent.
What are palpitations?
The NHS defines palpitations as when your heartbeat becomes more noticeable. You may feel it in your chest, neck or throat. It is described in different ways: a fast, pounding beat, an irregular beat with skipped or extra beats, thumping, or fluttering. It lasts from a few seconds to a few minutes or longer.
“Arrhythmia” means a problem with the heart rhythm. Palpitations are not always a sign of an arrhythmia. On the other hand, the NHS says some people with one type of arrhythmia (atrial fibrillation) have no symptoms at all and find out during another check.
What are the causes?
The NHS says palpitations are common and are rarely a sign of something serious. Everyday triggers are:
- Heavy exercise and lack of sleep
- Stress and anxiety
- Alcohol, caffeine, nicotine, and recreational or stimulant drugs
- Some medicines (see the leaflet)
- The menopause and sometimes pregnancy
Medical causes are: anaemia from iron deficiency, an overactive thyroid, an arrhythmia and heart valve disease. So if palpitations keep happening, do not put them down to stress alone.
Who should see a doctor?
The NHS says to make an appointment if:
- The palpitations keep happening or have become more frequent
- They last more than a few minutes
- You have heart disease
- There is a heart problem in the family
But if the palpitations come with chest pain, breathlessness or feeling faint right now, do not wait for an appointment. See the last section.
How are they investigated?
Questions about the symptoms and an examination are the first step. After that:
- ECG: small stickers on the skin record the electrical signal of the heart. The NHS says it is usually quick and painless.
- Portable ECG: a small device worn on a belt, usually for 24 to 48 hours and for up to 7 days. You cannot shower during this time.
- Exercise test: an ECG while walking on a treadmill or pedalling. It usually takes 40 to 60 minutes.
- Heart echo, plain chest X-ray and blood tests: the NHS lists these for AF, to check the rhythm and look for other causes.
The doctor needs to explain the ECG result. The NHS says the time to get the result depends on the type of ECG and is sometimes a few weeks.
Which of these tests are done at this clinic is not stated on this page.
What does treatment look like in general?
The NHS says treatment depends on the cause, and palpitations often need no treatment. If a heart problem is causing them, a medicine or a procedure to control the heartbeat may be needed.
For AF the NHS lists: regular monitoring, medicines to control the rate and rhythm, medicines that lower the risk of clots and stroke (anticoagulants), and procedures such as ablation, an electric shock to restore the rhythm, or fitting a pacemaker or an ICD device. If another illness or another medicine has caused it, treating that or changing the medicine may help. Every medicine decision is made only by a doctor.
What can you do yourself?
- Know your triggers. The NHS lists stress, smoking, caffeine and alcohol; for AF it also names too little sleep, dehydration and spicy food.
- Write down when it happens and how it feels. What you were doing, how it felt, how long it lasted. This note helps the doctor but is not a diagnosis. The guide “Tracking palpitations” has an example.
- Do not stop medicines on your own, even if you think they are the cause.
- Stay away from recreational and stimulant drugs, and cut down on alcohol and caffeine.
- Take your medicine list with you.
When to seek urgent care
Call 115 (Iran’s emergency number) and do not drive yourself if:
- The palpitations do not stop, or come with chest pain, breathlessness or feeling faint
- You have a fast or irregular heartbeat and at the same time any of these appear: cold sweat, nausea, fainting, dizziness or falling, severe headache, weakness or numbness on one side of the face or body, blurred or lost vision, confusion or trouble speaking
- You have fainted, especially during exercise or when lying down (NHS)
- Someone has collapsed and is not breathing
If the palpitations came with these signs and then stopped, still do not put off a check; in this case too the NHS says to contact a doctor urgently.
Symptoms and treatment plans differ from patient to patient. Talk to a doctor about your own situation.
Frequently asked questions
Are palpitations always dangerous?
No. The NHS says palpitations are common and usually harmless; lack of sleep, stress, coffee, alcohol, nicotine and some medicines can bring them on. But sometimes they point to a rhythm problem, anaemia, an overactive thyroid or valve disease. For this reason, if they keep happening they should be checked.
My ECG was normal but I still have palpitations. Why?
An ECG records only those few minutes. If the palpitations come and go, they may not have been happening at that moment. The NHS describes a portable ECG that stays with you for 24 to 48 hours and sometimes up to 7 days. Whether you need one is for your doctor to decide.
My palpitations came with breathlessness or fainting. What should I do?
The NHS says if the palpitations do not stop, or come with chest pain, breathlessness or feeling faint, call the emergency services. In Iran that is 115. Do not drive yourself.
What is atrial fibrillation (AF)?
A type of irregular heartbeat in which the heart rate is not steady. The NHS says it has no cure, but treatment can control the symptoms and reduce the risk of clots, stroke and heart failure. Some people have no symptoms and find out at an examination or another check.
What should I cut out for my own palpitations?
The NHS says if the cause is not an illness, staying away from triggers such as stress, smoking, caffeine and alcohol may help. Do not stop a medicine without a doctor's advice, even if you think it is the cause. Instead, tell your doctor about it.