Rhythm-Related Symptom
Palpitations
Palpitations are an awareness of the heartbeat: pounding, fluttering, racing or skipped beats. They are very common and often harmless, but they can also be the first sign of an arrhythmia worth identifying.
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Understanding the Symptom
What Are Palpitations?
Palpitations are not a diagnosis. They describe how a person perceives their heartbeat. Some people notice every beat while resting in bed, others only become aware when the rhythm truly changes.
The sensation may come from a normal heart reacting to stress, caffeine or illness, from isolated extra beats, or from a sustained arrhythmia such as atrial fibrillation or supraventricular tachycardia. The sensation alone cannot reliably tell these apart, so the rhythm during the symptom is what matters.
How It Feels
Common Descriptions
Skipped or extra beats
A pause followed by a forceful beat. Often related to premature atrial or ventricular beats.
Sudden racing
A rapid heartbeat that starts and stops abruptly, which may point to a re-entrant tachycardia.
Irregular fluttering
An uneven rhythm that can reflect atrial fibrillation or frequent premature beats.
Pounding in the neck
A strong, regular sensation that may accompany anxiety, exertion or some forms of SVT.
Possible Causes
Why Palpitations Occur
Everyday triggers
Caffeine, nicotine, alcohol, poor sleep, stress, dehydration and some decongestants or supplements.
Medical conditions
Thyroid overactivity, anaemia, fever, pregnancy and certain medicines can raise the heart rate or sensitivity to beats.
Heart rhythm disorders
Premature beats, supraventricular tachycardia, atrial fibrillation or flutter and, less often, ventricular arrhythmias.
Many people have palpitations with a structurally normal heart and no dangerous rhythm. Identifying which group applies is the purpose of the assessment.
Red Flags
When to Seek Prompt Medical Attention
Fainting or near-fainting
Palpitations with collapse, or dizziness that does not settle.
Chest pain or breathlessness
Symptoms during palpitations that suggest the heart is under strain.
Known heart disease or family history
A history of cardiomyopathy, sudden cardiac death or inherited rhythm disease.
Rapid or sustained episodes
A fast rhythm that does not settle within a short time.
In an emergency, call your local emergency number rather than waiting for an appointment.
Assessment
Finding the Rhythm Behind the Feeling
The goal is to capture an ECG while symptoms are present. The test is chosen according to how often the episodes occur.
History and examination
Pattern, duration, triggers, medicines and family history.
Shows baseline rhythm and signs such as pre-excitation.
Continuous recording over a day or longer, for frequent symptoms.
For less frequent episodes, activated by the patient when symptoms occur.
When symptoms are linked to effort.
Blood tests and echocardiography
To look for thyroid, anaemia, structural or functional heart problems.
What Next
Management Depends on the Cause
If a trigger is found, reducing it is often enough. When extra beats are documented, reassurance and monitoring may be appropriate, and treatment is reserved for symptomatic or frequent cases.
If an arrhythmia is confirmed, options may include medication, observation or catheter ablation, selected according to the rhythm. Examples are SVT and atrial fibrillation.
An electrophysiology study with 3D mapping may be considered when a re-entrant tachycardia is suspected but not yet documented.
Practical Guidance
What You Can Do Before Your Visit
Keep a short diary: when the episode started, how it felt, how long it lasted and what you were doing. Note your pulse if you can measure it, or record a smartwatch trace if you have one.
These notes help the physician choose the right monitor.
Bring a list of medicines and supplements, including over-the-counter products.
Read Before Your Visit to see what to prepare.
Questions
Frequently Asked Questions
Are palpitations always a sign of heart disease?
Can stress alone cause them?
Can a smartwatch diagnose the cause?
Will I need an ablation?
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