SYNTHETIC DEMONSTRATION — no real student or patient. Not a medical device.

cardiology

Heart Palpitations: Causes and When to See a Doctor

Heart palpitations — racing, fluttering, pounding, or skipped-beat sensations — are extremely common and most often harmless. Common triggers include caffeine, stress, dehydration, and poor sleep. A 2017 AAFP review and a 2024 update both confirm that history, physical exam, and a 12-lead EKG are sufficient to identify the etiology in most cases.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

What does a palpitation actually feel like?

People describe palpitations in different ways: a "flip-flop" in the chest, a heart that seems to skip or add a beat, a sudden rapid pounding, or a fluttering sensation in the throat or neck. The feeling can last a fraction of a second, several seconds, or — when caused by a true arrhythmia — minutes to hours.

Palpitations are among the most common symptoms prompting a cardiology or primary care visit. The majority are benign and self-limited, but a thorough history and 12-lead EKG are the essential first steps in determining whether further evaluation is needed 1.

What are the most common causes?

The majority of palpitations have a benign, lifestyle-related explanation 12:

  • Caffeine and stimulants — coffee, energy drinks, certain decongestants, and some dietary supplements can speed the heart or provoke ectopic beats
  • Stress and anxiety — psychological arousal activates the sympathetic nervous system, increasing heart rate and heightening awareness of heartbeats
  • Dehydration — reduced blood volume prompts a compensatory increase in heart rate
  • Poor sleep — sleep deprivation and sleep apnea both increase the frequency of ectopic beats
  • Alcohol — even moderate intake can trigger palpitations, particularly around the time of consumption or the morning after
  • Thyroid dysfunction — hyperthyroidism (overactive thyroid) can cause sustained rapid heart rate and palpitations
  • Anemia — reduced oxygen-carrying capacity drives a compensatory increase in heart rate
  • Certain medications — stimulant medications, some antibiotics, and over-the-counter cold remedies can provoke palpitations

In women, hormonal changes at menstruation, pregnancy, and perimenopause are also recognized triggers 2.

When are palpitations a sign of an arrhythmia?

Palpitations caused by a true arrhythmia range from completely benign to ones that warrant prompt evaluation 1. Common arrhythmias presenting as palpitations include:

  • Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) — the most common arrhythmic cause; usually felt as a "skipped beat." Isolated PACs and PVCs in people without underlying heart disease are generally benign.
  • Supraventricular tachycardia (SVT) — sudden-onset rapid regular heartbeat, often starting and stopping abruptly. Usually benign but can cause significant distress.
  • Atrial fibrillation (AFib) — irregular, disorganized atrial rhythm associated with a rapid, irregular ventricular response; clinically significant because of stroke risk 2.
  • Ventricular tachycardia — rapid, regular beats originating in the ventricles; potentially dangerous and requires specialist evaluation.

Features that increase the likelihood of a significant arrhythmia include palpitations starting and stopping abruptly, palpitations with syncope or near-syncope, palpitations that occur with exertion rather than at rest, and palpitations in someone with known structural heart disease 1.

What will a clinician do to evaluate palpitations?

A clinician evaluating palpitations will typically take a detailed history — including when episodes occur, how long they last, whether they start and stop abruptly, whether they are fast, slow, or irregular, and what makes them better or worse — and perform a focused physical exam 1.

The initial workup commonly includes:

  • 12-lead EKG — to identify a rhythm abnormality if one is present at the time
  • Basic blood tests — thyroid function, complete blood count (for anemia), and electrolytes
  • Holter monitor (24–48 hours) or extended ambulatory recorder — if symptoms are frequent enough to likely be captured over days to weeks 2
  • Echocardiogram — if structural heart disease or reduced ejection fraction is suspected

For palpitations that are very rare or unpredictable, wearable ECG technology (smartwatch or patch monitor) has shown diagnostic accuracy for arrhythmia detection and is increasingly used as an adjunct 2.

What lifestyle changes reduce palpitations?

Many people find significant improvement with adjustments that address lifestyle triggers:

  • Reduce caffeine progressively rather than stopping abruptly to avoid withdrawal headaches
  • Limit alcohol — even modest reductions help many people
  • Stay hydrated — aim for adequate fluid intake throughout the day, especially in warm weather or during exercise
  • Improve sleep — address sleep apnea if suspected; maintain consistent sleep and wake times
  • Manage stress — regular aerobic exercise, mindfulness, and adequate rest all reduce sympathetic nervous system tone

If palpitations began shortly after starting a new medication, discuss it with the prescribing clinician before stopping anything on your own.

Common questions

Are palpitations dangerous?

Most palpitations are not dangerous. Isolated premature beats in people without heart disease are almost universally benign. Palpitations accompanied by fainting, chest pain, or shortness of breath, or occurring in someone with known heart disease, require evaluation to rule out a significant arrhythmia.

When should I call a doctor about palpitations?

See a clinician if palpitations are new, frequent, prolonged (lasting more than a few minutes), associated with dizziness, or occurring in the context of known heart disease. Seek emergency care for palpitations with chest pain, fainting, or severe shortness of breath.

Can anxiety cause palpitations?

Yes — anxiety is one of the most common causes of palpitations. Activation of the sympathetic nervous system speeds the heart rate and heightens awareness of the heartbeat. Treating underlying anxiety often reduces palpitation frequency significantly.

Will I need a Holter monitor?

A Holter monitor is typically ordered when palpitations are frequent enough to likely be captured over 24–48 hours. If symptoms are more infrequent, a longer-term event monitor or wearable ECG device may be a better fit.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek care for palpitations

  • —Palpitations with chest pain or pressure
  • —Palpitations with fainting or near-fainting (pre-syncope)
  • —Palpitations with severe shortness of breath
  • —Sustained rapid heart rate (lasting more than 30 minutes) that does not resolve
  • —Palpitations in someone with known heart disease or a family history of sudden cardiac death

Call 911 or go to the nearest emergency department if palpitations are accompanied by chest pain, fainting, or severe difficulty breathing.

This article provides general health information only. It does not replace a personalized assessment by a licensed clinician. A Gale primary care clinician can evaluate your palpitations, order appropriate tests, and help you understand your results.

References

  1. 1.Wexler RK, Pleister A, Raman SV (2017). Palpitations: Evaluation in the Primary Care Setting. American Family Physician. PMID 29431371 ✓AAFP clinical review: history, physical examination, and 12-lead EKG as the initial framework for palpitations evaluation; cardiac causes most concerning; risk stratification based on features of the palpitation episode
  2. 2.Gauer RL, Thomas MF, McNutt RA (2024). Palpitations: Evaluation, Management, and Wearable Smart Devices. American Family Physician. link ✓Updated AAFP review: wearable smart devices with ECG monitoring show diagnostic accuracy for arrhythmia detection; comprehensive differential including AFib, SVT, and benign ectopic beats; hormonal triggers in women recognized

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.