Palpitations

Palpitations are when you suddenly become aware of your heart beating. This can feel alarming but is usually nothing to worry about. Palpitations often come and go quickly without any treatment.

On this page, you can find the following information:

What are palpitations?
What are the causes of palpitations?
What should I do if I have palpitations?
How are the causes of palpitations diagnosed?
How are palpitations treated?

Key points about palpitations

If you have palpitations, you may feel like your heart has added or missed a beat, is beating too fast or slow, or is fluttering or pounding.
There are many different causes of palpitations, some of which may need treatment.
Most palpitations are harmless and will go away on their own but they can be a sign of something more serious.
Your doctor will discuss the best treatment option for you depending on the cause of your palpitations.

See your doctor or go to the nearest emergency department if you or someone you care for has palpitations and any of the following symptoms:
feel unwell palpitations are severe and last for more than a few minutes shortness of breath dizziness a feeling of anxiety chest pain fainting or passing out (loss of consciousness) have had heart problems in the past.

What are palpitations?

Your heart usually beats regularly about 60–100 times per minute, and you don’t normally feel it. Palpitations are when you become aware of your heart beating. It may feel like your heart has added or missed a beat. It may feel fast or slow. Some people say it feels like their heart is racing, fluttering or pounding.

What are the causes of palpitations?

There are different causes of palpitations, including:

lifestyle factors
hormonal changes such as during periods, pregnancy and menopause
emotional or psychological causes
heart conditions
other health conditions
medicines.

Lifestyle factors

Palpitations can be brought on by lifestyle factors such as:

smoking
caffeine – found in coffee, tea, energy drinks, soft drinks
alcohol
recreational drugs such as cocaine, heroin, amphetamines, ecstasy and cannabis
not getting enough sleep
strenuous physical activity or exercise.

If you think lifestyle factors are causing your palpitations, you can take steps to reduce their effect on you. This may involve stopping smoking, drinking less caffeine and alcohol, avoiding recreational drugs or choosing a less intense form of exercise.

Periods, pregnancy or menopause

You may feel palpitations due to hormonal fluctuations and other changes caused by periods (especially heavy bleeding), pregnancy or menopause. These normally only last a short time and go away without causing any ongoing problems.

Emotional or psychological causes

Palpitations along with feeling frightened or worried may be due to emotional or psychological causes such as panic attacks, stress or anxiety. These can be very unsettling but normally do not cause any serious problems.

Heart conditions

Palpitations may also be caused by problems with your heart rhythm (arrhythmias) or other heart conditions.

Problems with your heart rhythm that can cause palpitations include:

ectopic beats
sinus tachycardia
atrial fibrillation
supraventricular tachycardia (SVT)
ventricular tachycardia.

Type of arrhythmias	Description
Ectopic beats – extra beats	You might feel extra heartbeats. These are called ectopic beats. This can feel like your heart has skipped a beat and the beat is irregular. Sometimes it feels like a stronger beat than usual. Ectopic beats can be felt when you are resting, but you may not feel them when you are active.
Sinus tachycardia – fast but regular	You may feel that your heartbeat is faster than usual but is still regular. There are many causes and can be normal when you exercise. Usually, this is harmless and settles by itself.
Atrial fibrillation – very fast and irregular	Atrial fibrillation (AF) is when your heartbeat is very fast and irregular. It can make you feel short of breath, dizzy and tired. It is more common if you are older and already have heart problems or high blood pressure. If it isn't treated, AF can cause stroke. See your GP or healthcare provider who will talk to you about treatment options. Read more about atrial fibrillation.
Supraventricular tachycardia (SVT) – very, very fast and regular	An SVT causes a very, very fast and regular heart rate. You may feel your heart racing but it then slows down by itself. Young people can get SVT. You often don’t need treatment as it’s usually harmless. If it keeps happening you may need to see your GP.
Ventricular tachycardia (VT)	A ventricular tachycardia is very fast but regular heart rate. This is a more serious condition and can be associated with dizziness and blackouts.

Heart conditions that can cause palpitations include:

heart valve problems
heart failure
hypertrophic cardiomyopathy
congenital heart disease.

Other medical conditions

Palpitations can be also caused by other health conditions such as:

low blood glucose (sugar), such as in diabetes
low blood pressure
low blood count (anaemia)
overactive thyroid
dehydration (lack of fluid in your body)
fever (high temperature)
electrolyte imbalance.

Medicines

Several commonly used medicines can cause palpitations, including some that you can buy over the counter at pharmacies. Talk to your doctor if you think your medicines are causing your palpitations. However, do not stop taking any prescribed medicines until after you have sought medical advice.

What should I do if I have palpitations?

Most of the time palpitations are harmless and will go away on their own. Sometimes they can be a sign of something more serious.

See your doctor or go to the nearest emergency department if you or someone you care for has palpitations and any of the following symptoms:
feel unwell palpitations are severe and last for more than a few minutes shortness of breath dizziness a feeling of anxiety chest pain fainting or passing out (loss of consciousness) have had heart problems in the past.

Even if your palpitations stop on their own and don't make you feel unwell you should still make an appointment to see your doctor or GP. Keep a diary of when they happen and how long they last. This information will help your doctor work out what is causing them.

How are the causes of palpitations diagnosed?

Your doctor will ask you questions about your symptoms, lifestyle, past and family medical history. Some questions they may ask include:

How often do you have palpitations?
How long do your palpitations last?
Are your palpitations triggered by anything?
Have you experienced any other symptoms along with palpitations?
Are you aware of your heartbeats being regular or irregular?
Have any of your family/whānau members died suddenly or from a cardiac arrest? This is especially important if they died young, eg, under 30 years old.

Your doctor will then examine you, including checking your pulse and blood pressure and listening to your heart. They may also ask you to have some tests, such as blood tests. Blood tests can find out if you have an underlying health condition that might cause your palpitations.

If your doctor suspects you might have a problem with your heart rhythm, you might be asked to have a test called an electrocardiogram (ECG). An ECG records the electrical activity of your heart at that moment in time. If your palpitations come and go, the ECG may not show them. You may be referred for a specialist test called a Holter monitor or 24-hour ECG. This is a small, portable ECG machine that you wear at home for 24–48 hours and it records your heart rhythm the whole time.

How are palpitations treated?

The treatment of your palpitations depends on the cause. You may not need any treatment and your palpitations may go away by themselves.

If your palpitations are caused by some of the lifestyle factors above, such as alcohol, smoking or caffeine-containing drinks, you should avoid or reduce their intake. If you feel stressed or anxious, try to identify what is causing this and find ways to relax. Read these tips for managing stress.

If your palpitations are caused by a heart rhythm problem such as atrial fibrillation, you may be prescribed medicines to help prevent blood clots and bring your heart's rhythm and speed back to normal. Read more about treatment for atrial fibrillation.

Occasionally, palpitations caused by a heart problem may need more specialist tests or treatment in hospital or by referral to a cardiologist (heart specialist).

Learn more

The following links provide further information about palpitations. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Heart palpitations HealthInfo Canterbury, NZ
Heart arrhythmias and palpitations Better Health Channel, Australia
Palpitations Patient Info, UK
Heart palpitations and ectopic beats NHS, UK

References

Palpitations Auckland Regional HealthPathways, NZ, 2021
Palpitations Patient Info, UK

Reviewed by

	Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.