Heart palpitations are moments when you become unusually aware of your heartbeat. They can feel like your heart is racing, pounding, skipping a beat, adding an extra beat, or doing a flip-flop in your chest. You might notice them in your chest, throat, or neck. Most palpitations are harmless and last only a few seconds, but understanding what causes them and which patterns deserve attention can save you a lot of worry.
What Palpitations Actually Feel Like
People describe heart palpitations in surprisingly different ways. Some feel a rapid fluttering, like a bird is beating its wings inside the chest. Others feel a hard, thumping pound that seems louder than a normal heartbeat. The most unsettling sensation for many people is the “skipped beat,” which feels like the heart pauses for a moment before lurching back into rhythm with an extra-strong thump.
That skipped-beat feeling usually comes from a premature heartbeat, either in the upper or lower chambers of the heart. The beat fires slightly early, and then there’s a brief pause before the next normal beat. Because the heart fills with a little extra blood during that pause, the following contraction is stronger than usual, which is the “thump” you notice. The premature beat itself is often too weak to feel, so you only register the forceful beat that follows it.
Common Triggers
Palpitations often show up after something stimulates your heart or nervous system. The most familiar triggers include caffeine, alcohol, nicotine, stress, poor sleep, and intense exercise. Dehydration and skipping meals can also set them off.
Caffeine’s relationship with palpitations is more nuanced than most people realize. In a randomized trial, participants who consumed coffee showed a 54% increase in premature ventricular contractions (the “skipped beat” type) compared to those who avoided it. Yet moderate, habitual coffee drinking, around one to three cups per day, has actually been linked to a lower risk of atrial fibrillation, a more serious irregular rhythm. The general recommendation is to keep caffeine under about 400 mg per day (roughly four 8-ounce cups of brewed coffee), but individual sensitivity varies widely. If two cups makes your heart race, your personal threshold is lower than average.
Alcohol and smoking both increase the risk of palpitations and more significant rhythm disturbances. For people who already experience episodes of irregular heartbeat, alcohol is one of the most commonly self-reported triggers, alongside caffeine, exercise, and lack of sleep.
Hormonal and Medical Causes
Hormonal shifts are a major and often overlooked cause. During menopause, dropping levels of estrogen, progesterone, and testosterone can trigger palpitations, sometimes alongside hot flushes. Pregnancy increases blood volume and heart rate, which can make palpitations more noticeable. In both cases, the palpitations typically reflect the body adapting to a new hormonal environment rather than a heart problem.
An overactive thyroid gland (hyperthyroidism) is one of the more important medical causes. Excess thyroid hormone directly speeds up the heart’s natural pacemaker and shifts the nervous system toward a more stimulated state, with heightened “fight or flight” activity and reduced calming signals. The result is a resting heart rate that’s noticeably faster than normal, often accompanied by a feeling of the heart pounding or racing. This combination of a fast pulse, unexplained weight loss, anxiety, and heat intolerance is a pattern worth mentioning to your doctor.
Anemia, particularly from iron deficiency, can also cause palpitations. When your blood carries less oxygen, the heart compensates by beating faster and harder, which you may feel as pounding or racing, especially during physical activity.
Benign Palpitations vs. Serious Arrhythmias
The vast majority of palpitations are harmless premature beats or momentary awareness of a normal heartbeat. But some palpitations signal a rhythm disturbance that needs medical attention. The two most common significant arrhythmias are atrial fibrillation (AFib) and supraventricular tachycardia (SVT), and they feel different from garden-variety palpitations.
AFib produces a chaotic, irregular rhythm. The heart’s upper chambers fire erratic electrical signals more than 300 times per minute, causing them to quiver instead of contracting normally. You might feel an irregular fluttering or notice that your pulse has no predictable pattern. Because the lower chambers also beat irregularly and may not fill with blood properly, AFib often comes with breathlessness and fatigue on top of the palpitation itself.
SVT creates a very fast but regular rhythm, sometimes reaching 200 beats per minute. If it lasts only a few seconds, it feels like a brief flip-flop or flutter. If it persists for more than a few minutes, reduced blood flow to the brain can make you feel dizzy, lightheaded, or short of breath.
The key differences to pay attention to: benign premature beats are brief (a beat or two), isolated, and leave you feeling fine otherwise. Arrhythmias like AFib or SVT tend to last longer, produce sustained racing or irregularity, and often come with dizziness, breathlessness, chest discomfort, or feeling faint. Palpitations paired with fainting, significant chest pain, or severe shortness of breath need prompt medical evaluation.
How Palpitations Are Diagnosed
The challenge with diagnosing palpitations is that they’re often gone by the time you see a doctor. A standard electrocardiogram (ECG) captures about 10 seconds of heart rhythm, which is helpful only if the palpitation happens to occur during the recording. For that reason, doctors often turn to longer-term monitoring.
A Holter monitor is a portable device you wear for 24 to 48 hours (some models record up to 7 days). It continuously records your heart rhythm so that any irregular beats can be captured and analyzed, even while you sleep. If your palpitations happen less often than every few days, a Holter may not catch them.
For less frequent episodes, an external loop recorder can be worn for three to four weeks. It continuously monitors your rhythm but saves recordings only when you press a button during symptoms or when the device detects an abnormality. This is useful when palpitations occur every two to three weeks.
For very infrequent but concerning episodes, an implantable loop recorder can be placed just under the skin of the chest. These tiny devices monitor heart rhythm continuously for up to three to four years, making them ideal for tracking down rare but potentially serious arrhythmias. There are also small handheld event recorders that capture 30 to 60 seconds of rhythm on demand when you press them against your chest. Because they only record when activated, their batteries last much longer and they can be used for extended periods.
Reducing Palpitations on Your Own
If your palpitations have been evaluated and found to be benign, lifestyle adjustments can make a real difference. Cutting back on caffeine, alcohol, and nicotine is often the first step. Managing stress through regular exercise, adequate sleep, and relaxation techniques can lower the baseline level of nervous system stimulation that primes the heart for extra beats.
Staying well hydrated and eating regular meals helps prevent the drops in blood volume and blood sugar that can trigger palpitations. If you notice palpitations during menopause, reducing alcohol intake has been shown to help with both hot flushes and heart-related symptoms.
Tracking when your palpitations happen, what you were doing, and what you consumed beforehand can reveal patterns you’d otherwise miss. That diary also becomes valuable information if you eventually need medical evaluation, giving your doctor a clearer picture than memory alone.