In short
Palpitations are the feeling of your heart pounding, fluttering, racing or skipping. They are common and often harmless, but sometimes they reflect an arrhythmia — an abnormal heart rhythm such as atrial fibrillation — that needs assessment and treatment.
When palpitations need emergency care
Seek emergency medical care immediately if palpitations come with:
- Chest pain or pressure
- Fainting, near-fainting or severe dizziness
- Severe breathlessness
- A very fast heartbeat that does not settle and makes you feel unwell
Busamed Hillcrest 24-Hour Emergency Unit: 031 768 8911. This information must never delay emergency care.
Palpitations versus arrhythmias
A palpitation is a sensation — something you notice. An arrhythmia is a measured change in the heart’s electrical rhythm. You can have palpitations with a normal rhythm, and some arrhythmias cause no noticeable symptoms at all. Linking the two requires recording the heart rhythm, ideally while symptoms are happening.
Common triggers that are not dangerous
Many palpitations are linked to everyday factors, including:
- Caffeine, alcohol, nicotine and some recreational drugs
- Stress, anxiety, poor sleep and dehydration
- Strenuous exercise, fever or pregnancy
- Some medicines, and conditions such as an overactive thyroid or anaemia
Atrial fibrillation and other arrhythmias
Atrial fibrillation (AF) is a common arrhythmia in which the upper chambers of the heart beat irregularly and often quickly. It can cause palpitations, tiredness or breathlessness, or no symptoms. AF matters partly because it increases the risk of stroke, which is why assessment and a discussion about stroke prevention are important.
Other rhythm problems include extra (ectopic) beats, which are very common and usually harmless, episodes of fast regular rhythm, and slow rhythms. Slow rhythms with symptoms such as fainting may, in specific circumstances, be treated with a pacemaker.
How heart rhythm is generally assessed
A clinician will ask how the palpitations feel, how long they last, what triggers them and whether you feel faint or breathless. A physical examination and blood tests may help identify contributing factors.
Generally, heart rhythm is recorded with an ECG and sometimes a portable monitor worn for a day or longer. An echocardiogram can check the heart’s structure. This is general information: the practice will confirm which investigations it can arrange for you.
Treatment
Many people need reassurance and attention to triggers only. Others benefit from medicines to control rate or rhythm, treatment to reduce stroke risk, or specialist procedures. The right approach depends on the specific rhythm and your overall health.
Questions to ask your clinical team
- Do my symptoms suggest a rhythm problem, or a harmless cause?
- How can we capture my heart rhythm when the palpitations happen?
- If I have atrial fibrillation, what is my stroke risk and how should it be managed?
- Should I avoid caffeine, alcohol or particular types of exercise?
Common questions
Are skipped beats dangerous?+
Occasional extra beats are very common and usually harmless, but frequent or troublesome symptoms, or symptoms with fainting or chest pain, should be assessed.
What should I note down before my appointment?+
When the palpitations happen, how long they last, whether they are regular or irregular, any triggers, and whether you felt faint or breathless. If you can safely check your pulse during an episode, note the rate.
Sources and further reading
General patient education written in plain language and informed by the sources above. It is not a substitute for an individual assessment, and does not describe practice-specific fees, referral rules or preparation — please confirm these with the practice.