A heart palpitation feels like your heart is fluttering, pounding, thumping, or briefly skipping a beat. Some people describe it as a flip-flopping sensation in the chest, while others notice a sudden, forceful thump that seems louder or stronger than a normal heartbeat. You can feel palpitations not just in your chest but also in your throat or neck, which often catches people off guard.
The Different Sensations
Palpitations don’t feel the same for everyone, and the sensation depends on what your heart is actually doing in that moment. The most common types break down into a few distinct patterns:
- Skipped or extra beats. This feels like your heart pauses for a moment, then delivers a single hard thump. It can feel like a jolt or a “catch” in your chest. Ironically, the sensation you notice isn’t the skipped beat itself. It’s what happens right after: the pause gives your heart an extra fraction of a second to fill with blood, so the next contraction is stronger than usual. That forceful beat is what you actually feel.
- Fluttering or quivering. This feels like a butterfly or a vibration inside your chest. It’s lighter and less dramatic than a thump, and it can last a few seconds or come in brief waves.
- Racing or pounding. Your heart feels like it’s beating unusually fast, hard, or both. You might feel it hammering against your ribcage, or sense a rapid pulse in your neck. This is the type most associated with anxiety, exercise, or caffeine.
Some people experience only one of these patterns; others get a mix. A cardiologist at Johns Hopkins describes asking patients to tap out the rhythm they feel with their hand, because the pattern itself helps distinguish between isolated skipped beats and a more sustained irregular rhythm.
Where You Feel Them
Most people notice palpitations in the center or left side of the chest, but the sensation frequently shows up in the throat or neck too. That’s because large blood vessels run through those areas, and a forceful or irregular heartbeat creates a pulse wave you can feel there. If you’ve ever noticed a sudden throb in your neck that seems out of rhythm, that’s a palpitation, not a separate problem.
What Triggers Them
Anxiety is the most common non-cardiac cause of palpitations. When you feel stressed or anxious, your nervous system activates a fight-or-flight response that directly speeds up your heart rate. Situations like job interviews, public speaking, or flying can be enough to set this off. The palpitations are real, not imagined. Your heart is genuinely beating differently, even though nothing is structurally wrong with it.
Caffeine and alcohol are the other major triggers. Both can make your heart more prone to extra beats or brief runs of fast rhythm. Dehydration, poor sleep, and hormonal changes (particularly during menstruation, pregnancy, or perimenopause) can also bring them on. Many people notice palpitations more when lying in bed at night, simply because the quiet environment makes it easier to feel each heartbeat.
Anxiety Palpitations vs. Sustained Arrhythmias
There’s a meaningful difference between occasional skipped beats and a sustained episode of rapid, irregular rhythm. Anxiety-related palpitations tend to come in short bursts. Your heart might pound for a few seconds to a few minutes, usually with a clear trigger like stress or a cup of coffee, and then settle back to normal on its own.
A sustained arrhythmia like supraventricular tachycardia feels different. It comes on suddenly, often with no obvious trigger, and the heart may race at 150 beats per minute or higher. Rather than a few noticeable thumps, you feel a continuous rapid fluttering or hammering that can last minutes to hours. Dizziness, lightheadedness, or a feeling of pressure in the chest often accompanies it. The onset and offset tend to be abrupt, like a switch flipping, rather than a gradual buildup.
How Common They Are
Palpitations are extremely common. Most adults experience them at some point, and the vast majority are harmless. A study of over 500,000 adults published in Circulation found that only about 2.35% had a detectable rhythm abnormality on a baseline heart recording, and that number was even lower in people under 55 (just under 1%). In other words, the odds are strongly in your favor that an occasional flutter or skipped beat is benign.
That said, palpitations become more common with age. In the same study, about 4.8% of adults 65 and older had a rhythm abnormality, compared to less than 1% of younger adults.
Signs That Need Prompt Attention
Most palpitations are harmless, but certain combinations of symptoms suggest something more serious is going on. Seek emergency care if palpitations come with chest pain that lasts more than a few minutes, dizziness or fainting, or significant shortness of breath. Palpitations that happen during heavy exertion and cause you to feel faint also warrant urgent evaluation.
Other patterns worth getting checked out (not urgently, but soon) include palpitations that are becoming more frequent over weeks, episodes lasting longer than a few minutes, or a resting heart rate that stays above 100 beats per minute.
How Palpitations Are Evaluated
The challenge with diagnosing palpitations is that they’re often gone by the time you’re sitting in a doctor’s office. The initial workup typically starts with a physical exam, including listening to your heart with a stethoscope and checking your thyroid. An electrocardiogram (a painless test that records your heart’s electrical activity) is standard, but it only captures what’s happening in that moment.
If the ECG looks normal but you’re still having episodes, the next step is usually a portable heart monitor. A Holter monitor is a small device you wear for a day or more that continuously records your heart rhythm during normal activities. For palpitations that happen less than once a week, an event recorder works better. You wear it for up to 30 days and press a button when you feel symptoms, which captures the rhythm at that exact moment. This is the most reliable way to match what you’re feeling to what your heart is actually doing.
Tracking Episodes at Home
If you plan to talk to a doctor about palpitations, keeping a brief log of your episodes makes a real difference in the evaluation. For each episode, jot down the date and time, what the sensation felt like, what you were doing right before it started, and roughly how long it lasted. Patterns often emerge quickly. You might notice that your palpitations cluster after your second coffee, after poor sleep, or during high-stress workdays. That context helps distinguish a harmless trigger from something that needs further testing.