Heart palpitations are moments when you become suddenly aware of your heartbeat, and they’re one of the most common reasons people worry about their heart. You might feel a fluttering, pounding, racing, or skipping sensation in your chest, throat, or neck. Most of the time, palpitations are harmless and triggered by something identifiable, but in some cases they signal a rhythm problem worth investigating.
What Palpitations Actually Feel Like
People describe palpitations differently depending on what’s happening electrically in the heart. A “skipped beat” usually means a premature contraction, where the heart fires slightly early and then pauses before the next beat. That pause makes the following beat feel unusually strong. A “fluttering” sensation often reflects a brief run of rapid, irregular beats. A “pounding” or “racing” feeling can mean your heart rate has genuinely increased, sometimes to 150 beats per minute or more, even while you’re sitting still.
Some episodes last only a second or two. Others persist for minutes. The duration and what accompanies them matter far more than the palpitations themselves when it comes to determining whether something serious is going on.
Common Triggers That Aren’t Heart Disease
The majority of palpitations trace back to something outside the heart. Caffeine, nicotine, and alcohol are classic triggers. Cold and cough medications containing pseudoephedrine can do it too, as can stimulants like amphetamines and cocaine. Even a large meal or dehydration can set off a noticeable episode.
Strong emotions are another frequent cause. Stress, anxiety, and panic attacks activate your body’s fight-or-flight response, which ramps up your heart rate. Your autonomic nervous system, the part of your brain that controls heart rate, breathing, and digestion, responds to perceived threats by flooding your body with adrenaline. The result is a heart that races or pounds even though nothing is physically wrong with it. Palpitations caused by anxiety tend to start suddenly and resolve within a few minutes once the emotional trigger passes.
Hormonal shifts matter too. An overactive thyroid gland causes the heart to beat harder and faster, and it can trigger abnormal rhythms like atrial fibrillation. On the other end, an underactive thyroid slows the heart and raises blood pressure. Low levels of potassium or magnesium, both essential for normal electrical signaling in heart cells, can also produce noticeable rhythm changes.
Palpitations During Pregnancy
Pregnancy is a particularly common time for palpitations, and the reason is straightforward: your blood volume increases by nearly 50% over the course of nine months. Your heart has to pump significantly harder and faster to supply blood to both your body and the growing fetus. Hormonal shifts in estrogen add to the effect. Most pregnancy-related palpitations are benign, but episodes paired with chest pain, difficulty breathing, fainting, or severe swelling in the legs and ankles warrant immediate attention.
When Palpitations Point to a Heart Rhythm Problem
About 2.35% of adults have a detectable rhythm abnormality, and that number rises with age. Among people under 55, the rate sits below 1%. For those 65 and older, it jumps to nearly 5%. Atrial fibrillation is the most common type in the U.S., a condition where the heart’s upper chambers beat in a chaotic, disorganized pattern instead of contracting smoothly.
Other rhythm issues that cause palpitations include supraventricular tachycardia (SVT), where a rapid heartbeat originates in the upper chambers, and ventricular arrhythmias, which start in the lower chambers and can be more serious. Myocarditis, an inflammation of the heart muscle often caused by a viral infection, and structural issues like valve disease can also produce palpitations.
The key distinction is pattern. Anxiety-driven palpitations come and go quickly and are tied to emotional states. Palpitations from an arrhythmia tend to recur without an obvious trigger, may last longer, and are more likely to show up alongside other symptoms like dizziness or breathlessness.
How to Stop an Episode
Vagal maneuvers are simple physical techniques that stimulate your vagus nerve, which helps slow your heart rate. They work best for supraventricular tachycardia but can sometimes ease other types of rapid palpitations.
- Valsalva maneuver: Lie on your back, take a deep breath, then bear down as if you’re trying to exhale through a blocked straw, keeping your nose and mouth closed, for 10 to 30 seconds.
- Diving reflex: While sitting, take several deep breaths, hold, and submerge your entire face in a container of ice water for as long as you can. If that’s impractical, press an ice-cold wet towel against your face.
- Coughing forcefully or gagging briefly can also trigger the vagus nerve enough to interrupt a fast rhythm.
For longer-term prevention, the basics matter: staying well hydrated, limiting caffeine and alcohol, getting consistent sleep, and managing stress. If palpitations are linked to anxiety, addressing the anxiety itself, whether through therapy, breathing exercises, or other approaches, often reduces the cardiac symptoms.
Red Flags That Need Immediate Attention
Most palpitations are not emergencies, but a few combinations of symptoms change the picture. Sudden collapse or loss of consciousness calls for an immediate trip to the emergency department. Palpitations paired with dizziness, lightheadedness, or confusion also warrant urgent evaluation, because these suggest your heart may not be pumping enough blood to your brain. Chest pain alongside palpitations is another clear signal to get help right away.
Sustained palpitations that don’t resolve within a few minutes, especially if they come with shortness of breath, are less likely to be anxiety-related and more likely to reflect an underlying rhythm issue that a provider can evaluate with an EKG or a portable heart monitor.