Heart palpitations are moments when you become unusually aware of your heartbeat. They can feel like your heart is racing, pounding, skipping a beat, or doing a flip-flop in your chest. They’re extremely common, accounting for 16% of visits to primary care doctors and ranking as the second most common reason people see a cardiologist. Most of the time, palpitations are harmless and short-lived, but they can occasionally signal something that needs attention.
What Palpitations Actually Feel Like
People describe palpitations in different ways depending on what’s happening electrically in the heart. You might feel a sudden fluttering sensation, like a butterfly is trapped in your chest. Or it might be more like a hard thump or pounding that you can feel in your neck or throat. Some people notice what feels like a skipped beat followed by an extra-strong beat, which is often an extra heartbeat (the skip is the pause before it, and the thump is the heart contracting more forcefully to catch up). Others experience a sustained racing sensation that starts and stops abruptly.
Palpitations can last a fraction of a second or go on for minutes. They happen at rest, during exercise, or while lying in bed at night when there’s less sensory input competing for your attention. The experience itself is usually more alarming than dangerous, but the sensation alone can trigger anxiety, which then makes the palpitations worse.
Common Triggers That Aren’t Heart Problems
The majority of palpitations come from everyday substances and emotional states rather than structural heart disease. Caffeine, nicotine, alcohol, and even spicy food can all activate your body’s fight-or-flight response, releasing stress hormones that speed up your heart rate and make each beat feel more forceful. Stress and anxiety do the same thing. When you’re anxious, your nervous system floods your body with signals designed to prepare you for a physical threat, and a pounding heart is part of that package.
Several common medications can also cause palpitations as a side effect. Decongestants (the kind found in cold and sinus medications), drugs used in asthma inhalers, and certain blood pressure medications called vasodilators are frequent culprits. If palpitations started around the time you began a new medication, that connection is worth exploring.
Dehydration, poor sleep, and hormonal shifts during menstruation, pregnancy, or menopause are other well-known triggers. In most of these cases, addressing the trigger resolves the palpitations entirely.
Medical Conditions That Cause Palpitations
When palpitations aren’t triggered by lifestyle factors, a handful of medical conditions are typically responsible.
Premature Heartbeats
The most common cardiac cause is premature heartbeats, which are extra beats that originate in either the upper or lower chambers of the heart. The ones from the lower chambers (called PVCs) are especially common and usually benign. Nearly everyone has them occasionally. They create that classic “skipped beat” sensation. In rare cases, having very frequent premature beats over a long period can weaken the heart muscle, so persistent episodes are worth getting checked.
Atrial Fibrillation
Atrial fibrillation, or AFib, occurs when chaotic electrical signals cause the upper chambers of the heart to quiver instead of contracting in an organized way. This produces an irregular and often very fast heartbeat. AFib episodes can come and go on their own or become persistent. The condition is linked to an increased risk of stroke, which is why it requires medical management even when the symptoms feel tolerable.
Supraventricular Tachycardia
This is a broad category of fast heart rhythms that originate above the lower chambers of the heart. The hallmark is a pounding heartbeat that starts and stops suddenly, almost like flipping a switch. Episodes can last seconds to hours and, while usually not dangerous, can be very uncomfortable.
Thyroid Problems
An overactive thyroid gland produces excess hormones that directly stimulate the heart. A fast resting heart rate is recorded in almost all patients with hyperthyroidism, and the condition is one of the most common medical causes of atrial fibrillation. If you’re experiencing palpitations along with unexplained weight loss, heat intolerance, or trembling hands, thyroid function is one of the first things a doctor will check.
Anemia
When your blood doesn’t carry enough oxygen (often due to iron deficiency), your heart compensates by beating faster and harder to deliver what your tissues need. This can produce noticeable palpitations, especially during physical activity. Fatigue, pale skin, and shortness of breath alongside palpitations are clues that anemia may be involved.
POTS
Postural orthostatic tachycardia syndrome causes your heart rate to spike when you move from sitting or lying down to standing up. Palpitations and a racing heart are core symptoms, often accompanied by lightheadedness and sometimes chest pain. POTS can develop after a significant viral illness or infection, and it has received more attention in recent years due to its connection with post-viral syndromes. If your palpitations consistently appear when you stand up and improve when you sit or lie down, POTS is worth discussing with a doctor.
How Palpitations Are Diagnosed
The tricky part of diagnosing palpitations is that they’re often gone by the time you’re sitting in a doctor’s office. A standard electrocardiogram (EKG) gives a snapshot of your heart’s electrical activity, but it only captures about 10 seconds. If your heart rhythm is normal during that window, the EKG will look fine even if you’ve been having episodes all week.
That’s where longer-term monitoring comes in. A Holter monitor is a small, portable device you wear for 24 hours or more that continuously records your heart’s electrical signals. Think of it as a movie of your heart rhythm compared to the single photograph an EKG provides. If your palpitations are less frequent, a cardiac event recorder may be a better fit. These devices attach with patches, bracelets, or finger clips and can be worn for a month or two, capturing data only when you activate the device or when it detects an abnormal rhythm.
Your doctor may also order blood tests to check your thyroid function, iron levels, and electrolytes. An echocardiogram, which uses ultrasound to create images of the heart’s structure and movement, can identify problems with the heart’s valves or muscle that might explain the symptoms. In some cases, a stress test on a treadmill or stationary bike is used to provoke palpitations in a controlled setting where they can be studied.
Techniques for Stopping an Episode
For certain types of fast heart rhythms, vagal maneuvers can help break the cycle by stimulating the vagus nerve, which acts as a brake on heart rate. These work best for supraventricular tachycardia and should be discussed with your doctor before you try them at home.
The Valsalva maneuver involves taking a deep breath and then bearing down as if you’re trying to exhale through a blocked straw, holding for 10 to 30 seconds. A modified version, where you then quickly bring your knees to your chest or elevate your legs for an additional 30 to 45 seconds, tends to work better. The diving reflex is another option: take several deep breaths, hold, and submerge your face in a bowl of ice water (or press an ice-cold wet towel to your face). The cold triggers a reflexive slowing of the heart rate.
Beyond acute maneuvers, reducing or eliminating caffeine, alcohol, and nicotine often cuts palpitation frequency dramatically. Managing stress through regular exercise, adequate sleep, and breathing techniques addresses one of the most common underlying drivers.
Warning Signs That Need Urgent Attention
Most palpitations don’t require emergency care, but a few combinations of symptoms do. Palpitations with sudden collapse or loss of consciousness warrant an immediate trip to the emergency department. The same goes for a racing heart accompanied by dizziness or lightheadedness, which can indicate that the heart isn’t pumping effectively. Chest pain during palpitations is another red flag that may require urgent evaluation.
Family history matters too, particularly for younger people. If a close relative experienced sudden cardiac death at a young age or was diagnosed with an inherited heart condition, palpitations deserve a more thorough workup even if they seem benign on the surface. In these cases, the palpitations themselves may be minor, but they can be an early signal of an electrical disorder in the heart that carries real risk.