Heart palpitations are feelings that your heart is pounding, racing, fluttering, or skipping beats. They’re one of the most common reasons people visit a doctor, accounting for 16% of visits to primary care physicians and ranking as the second most common reason for seeing a cardiologist. Most of the time, palpitations are harmless and pass on their own, but they can occasionally signal an underlying heart rhythm problem worth investigating.
What Palpitations Actually Feel Like
People describe palpitations in a few distinct ways. You might feel a rapid pounding in your chest, a flip-flopping sensation, or a fluttering that lasts a few seconds to several minutes. Some people notice what feels like their heart skipping a beat or pausing briefly before resuming. These sensations aren’t limited to your chest. Many people feel them in their throat or neck, which can be especially unsettling.
Your heart rhythm may be completely normal during a palpitation episode. What you’re experiencing is sometimes just a heightened awareness of your own heartbeat, often triggered by stress, exertion, or lying in a quiet room. Other times, the sensation reflects an actual change in your heart’s rhythm or rate.
Common Triggers
The most frequently reported triggers are alcohol, caffeine, exercise, and lack of sleep. These tend to cluster together in people who are prone to palpitations, meaning if one triggers an episode, the others likely will too. Emotional stress, anxiety, and panic attacks are also major contributors. Nicotine and certain cold medications containing stimulants can set them off as well.
Dehydration and skipping meals sometimes play a role, since both can shift the balance of electrolytes like potassium and magnesium that help regulate your heart’s electrical signals. Even something as simple as eating a large meal can temporarily redirect blood flow and make your heart work harder, producing that pounding sensation.
Why Your Heart Misfires
Your heart has its own electrical system that coordinates each beat. Palpitations often come from one of two glitches in that system. The first is when a small group of heart cells outside the heart’s natural pacemaker fires off an impulse on its own, producing an extra or early beat. These are the “skipped beat” sensations most people feel. The second involves an electrical signal getting caught in a loop, circling back through tissue that has already recovered, creating a rapid sustained rhythm. This looping mechanism is what causes the sudden-onset racing that some people experience.
Heart Rhythm Conditions Behind Palpitations
Several specific rhythm disorders can cause palpitations. The most common is atrial fibrillation (AFib), where the heart’s upper chambers quiver chaotically instead of contracting in an organized way. AFib becomes more common with age and often brings fatigue, chest discomfort, or shortness of breath alongside the palpitations. Episodes can come and go (paroxysmal AFib) or persist for longer stretches.
Premature ventricular complexes, or PVCs, are single extra beats that interrupt the normal sequence. Most people never feel them, but some notice a fluttering or thumping in the chest, particularly at rest or while lying on their back. PVCs are extremely common and almost always benign in people with otherwise healthy hearts.
Supraventricular tachycardia (SVT) is another cause. It produces a sudden episode of rapid heartbeat, often 150 to 250 beats per minute, that starts and stops abruptly. In the general population, SVT occurs at a rate of about 35 new cases per 100,000 people each year.
Non-Heart Causes
Not all palpitations originate from a heart problem. An overactive thyroid gland speeds up your metabolism and can push your heart rate higher than normal, creating a persistent sense of racing. Anemia, where your blood carries less oxygen than it should, forces the heart to pump faster to compensate, which you may feel as pounding or fluttering.
Electrolyte imbalances play a critical role in heart rhythm. Potassium, magnesium, and calcium all help regulate the electrical signals that coordinate each heartbeat. When these minerals fall out of balance (from illness, dehydration, certain medications, or poor nutrition), irregular or fast heart rhythms can result.
Hormonal shifts are another common trigger. Heart palpitations during pregnancy are very common, especially in the third trimester, driven by increased blood volume and changing estrogen levels. Menopause produces similar hormonal fluctuations that can provoke episodes in people who never experienced them before.
How Palpitations Are Diagnosed
The challenge with palpitations is that they often come and go unpredictably, which means your heart might behave perfectly during a doctor’s visit. The first step is usually an electrocardiogram (ECG), a quick, painless test where sticky patches on your chest record your heart’s electrical activity. If the ECG looks normal but your symptoms persist, the next step is typically a portable monitor you wear at home.
A Holter monitor records your heart rhythm continuously for one to two days while you go about your normal routine. If your episodes happen less frequently than once a week, an event recorder is a better option. You wear it for up to 30 days and press a button when symptoms occur, capturing the rhythm at that exact moment. Many smartwatches now offer ECG features that can serve a similar purpose, though their readings are less detailed.
An echocardiogram, which uses sound waves to create a moving image of your heart, may be ordered if there’s concern about a structural problem. Chest X-rays are sometimes included to rule out lung-related causes.
Managing and Stopping Episodes
For palpitations triggered by lifestyle factors, the fix is often straightforward: cut back on caffeine and alcohol, prioritize sleep, manage stress, and stay hydrated. These changes alone resolve symptoms for many people.
When a fast-rhythm episode strikes, a technique called a vagal maneuver can sometimes stop it. The goal is to stimulate the nerve that slows your heart rate. One common method involves bearing down as if straining during a bowel movement (called the Valsalva maneuver). A modified version, where you bear down while sitting upright and then immediately lie flat with your legs raised to a 45- to 90-degree angle for about a minute, has a success rate of around 40% for converting certain fast rhythms back to normal. Splashing cold water on your face activates a similar reflex.
These maneuvers work best for supraventricular tachycardia and are considered the first-line response before medication. If two or three attempts fail, medical treatment with rhythm-controlling medications is the next step. For people with frequent, disruptive episodes that don’t respond to medication, a procedure called catheter ablation can target and disable the specific cells or pathways causing the misfiring.
Symptoms That Need Urgent Attention
Palpitations accompanied by chest pain, significant shortness of breath, dizziness, or fainting warrant immediate medical evaluation. The same applies if episodes last more than a few minutes and don’t resolve on their own, or if you have a known history of heart disease. Palpitations that start during physical exertion and worsen rather than settling down after you stop are also a red flag. Isolated, brief fluttering that passes within seconds and leaves you feeling fine is rarely dangerous, but any pattern of worsening frequency or intensity is worth getting checked.