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.

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.

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.

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

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.

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.

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).