--- title: "Palpitations: what causes them and when to have them checked" description: "What palpitations feel like, which patterns matter clinically, how heart rhythm is recorded and when a cardiology assessment is worthwhile." url: "https://www.drmartins.org/symptoms/palpitations/" author: "Dr Joao Martins" medical_reviewer: "Dr Joao Martins" review_status: "approved" date_published: "2026-09-01" date_modified: "2026-09-01" --- # Palpitations: what causes them and when to have them checked Palpitations are an awareness of your own heartbeat, often described as racing, pounding, fluttering or skipping. They are common and frequently harmless, particularly when brief and not accompanied by other symptoms. Investigation is more clearly warranted when palpitations are sustained, when they start and stop abruptly, when they occur during exertion, or when they come with chest pain, breathlessness, dizziness or fainting. Assessment aims to record the rhythm during symptoms and to establish whether the heart is otherwise structurally normal. ## When to seek urgent help Call 999 if palpitations occur with chest pain, severe breathlessness, or if you faint or nearly faint. Seek urgent medical advice if a fast, regular heartbeat starts suddenly and does not settle within a few minutes. ## Key facts - Occasional extra or missed beats are very common and are frequently harmless in a structurally normal heart. - What matters most is whether the sensation is regular or irregular, how it starts and stops, and what accompanies it. - Caffeine, alcohol, dehydration, poor sleep, stress, thyroid problems, anaemia and some medicines can all provoke palpitations. - A resting ECG only records the rhythm at that moment; intermittent symptoms may need longer monitoring. - Atrial fibrillation matters because of stroke risk, and that risk can be assessed and managed once the rhythm is documented. ## What people mean by palpitations Palpitations are not a diagnosis; they are a description. Some people notice a single strong beat, or the sensation of a beat being missed and then followed by a thump. Others describe a sustained fast heartbeat, a fluttering in the chest or throat, or a rhythm that feels chaotic. Each of these points in a slightly different direction, which is why the description is worth getting right. Extra beats, sometimes called ectopic beats, are extremely common. In a heart that is structurally normal they are usually harmless, even when they are frequent enough to be a nuisance. Understanding that they are benign often reduces how troublesome they feel. ## The details that change the assessment Several features carry weight. Whether the fast heartbeat is regular or irregular; whether it starts and stops abruptly or builds and settles gradually; how long episodes last; whether they occur at rest, during exertion or after it; and whether they are accompanied by chest discomfort, breathlessness, light-headedness or fainting. Fainting during palpitations, or palpitations that begin during physical exertion, are the features that most reliably prompt fuller investigation. A family history of sudden cardiac death or inherited heart conditions also changes the approach. ## Triggers worth reviewing Caffeine, alcohol, nicotine, recreational stimulants, dehydration, disturbed sleep and periods of stress can all provoke palpitations. So can an overactive thyroid, anaemia, fever, and some prescription and over-the-counter medicines, including certain decongestants and inhalers. Reviewing these is a routine part of the consultation, and sometimes the explanation is found there. ## How the rhythm is recorded The aim is to capture what the heart is actually doing while you feel the symptom. A resting ECG takes a snapshot and may be entirely normal between episodes. Where symptoms are intermittent, a longer period of ambulatory monitoring may be arranged: a small recorder worn for a day, several days or longer, depending on how often symptoms occur. An echocardiogram may be used alongside this to assess the structure and function of the heart, since the significance of a rhythm disturbance depends partly on whether the heart is otherwise normal. Blood tests, including thyroid function and a check for anaemia, are often appropriate. ## What happens after a diagnosis If the recording shows only ectopic beats in a normal heart, reassurance and attention to triggers may be all that is needed. If a sustained rhythm disturbance such as atrial fibrillation or a supraventricular tachycardia is documented, there are established treatment options, and the choice depends on how troublesome symptoms are, the underlying rhythm and, in the case of atrial fibrillation, your individual stroke risk. Those options are explained in full before anything is decided. ## Sources - [Heart palpitations and ectopic beats](https://www.nhs.uk/conditions/heart-palpitations/) — NHS - [Palpitations](https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/palpitations) — British Heart Foundation --- General information only. It does not replace individual medical advice, diagnosis or emergency care. In an emergency call 999.