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, eg, 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 including:

• smoking
• caffeine – found in coffee, tea, energy drinks, soft drinks
• alcohol
• recreational drugs, eg, 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, eg, panic attacks, stress or anxiety. These can be very unsettling but don't normally cause any serious problems.

Heart conditions

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

Rhythm problems that can cause palpitations include:

• Ectopic beats: These are extra heartbeats. We all get them and they are nearly always harmless. You don't normally notice them. If you’re lying still you may notice them as a skipped beat or stronger than usual beat in your chest. Caffeine in tea or coffee, and alcohol may cause you to have more ectopic beats than usual.  
• Sinus tachycardia: When your heart rate speeds up, eg, when you're exercising, anxious or have a fever. The rhythm is regular. 
• If your heart beat is very slow, irregular or faster than 100 beats per minute with no clear reason, or if you feel unwell it could be another type of arrhythmia. 

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, eg: 

• low blood glucose, eg, 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, don't stop taking any prescribed medicines until you've got some 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.

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 healthcare provider. Keep a diary of when they happen and how long they last. This information will help your healthcare provider work out what's causing them.

Your healthcare provider 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 healthcare provider 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 (eg, blood tests). Blood tests can find out if you have an underlying health condition that might cause your palpitations.

If your healthcare provider 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 (eg, alcohol, smoking or caffeine-containing drinks) you should avoid or reduce your 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 you may be prescribed medicines

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

Apps reviewed by Healthify

You may find it useful to look at some mental health and wellbeing apps and heart rate apps.