Heart palpitations are unusual sensations of your heartbeat that you wouldn’t normally notice. They can feel like your heart is racing, pounding, fluttering, flip-flopping, or skipping a beat. You might feel them in your chest, neck, or throat. Palpitations are extremely common and account for about 16% of all visits to primary care doctors, making them one of the top reasons people seek medical attention.
What Palpitations Actually Feel Like
Most of the time, your heart beats in the background without you noticing. Palpitations are the moments when that changes. People describe them in several ways: a sudden pounding or racing sensation, a feeling that the heart “skipped” or added an extra beat, or a fluttering that seems to come from nowhere. Some episodes last only a second or two. Others can persist for minutes.
The “skipped beat” sensation is one of the most common and has a straightforward explanation. An electrical signal tells the heart to beat slightly too early, creating a brief pause. The next beat is then stronger than usual to compensate. That pause-then-thump pattern is what you feel, even though your heart didn’t actually stop.
Common Triggers
In roughly 31% of cases evaluated by doctors, palpitations turn out to be driven by stress, anxiety, or other psychological factors rather than a heart problem. When you feel anxious or threatened, your body’s fight-or-flight system kicks in and increases your heart rate. You don’t need to be in actual danger for this to happen. Everyday stress, a panic attack, or even general unease can trigger it.
Lifestyle substances are another frequent cause, responsible for about 6% of diagnosed cases. Alcohol makes the heart more electrically unstable and raises the risk of irregular rhythms. High doses of caffeine, particularly from energy drinks, can do the same. Nicotine and certain recreational drugs are also well-known triggers. Dehydration, poor sleep, and intense exercise can all play a role too.
Medical Conditions That Cause Them
Sometimes palpitations point to something happening elsewhere in the body. An overactive thyroid gland is a classic example. Excess thyroid hormone forces the heart to beat harder and faster, and it can trigger disorganized rhythms in the heart’s upper chambers. People with an overactive thyroid often notice a racing or fluttering heartbeat as one of their first symptoms.
Other systemic causes include anemia (where the heart works harder to move oxygen-poor blood), electrolyte imbalances involving potassium or magnesium, high blood pressure, and sleep apnea. Hormonal shifts during pregnancy can also increase palpitations, partly because blood volume rises significantly and estrogen levels change. Fever and certain medications, including some decongestants and asthma inhalers, are additional culprits.
Heart Rhythm Disorders Behind Palpitations
About 28% of palpitation cases involve an actual arrhythmia, meaning the heart’s electrical system isn’t firing correctly. The most common is atrial fibrillation, which affects more than 2.5 million people in the United States. In atrial fibrillation, the upper chambers of the heart fire chaotically at rates above 400 beats per minute, though the lower chambers don’t follow that fast. The result feels like a rapid, irregular flutter.
Supraventricular tachycardia (SVT) is another type, responsible for about 10% of palpitation cases. SVT starts and stops suddenly, often producing a sensation of the heart abruptly racing and then snapping back to normal. Premature ventricular contractions, or PVCs, are the extra beats that cause that classic “skipped beat” feeling. They’re very common and usually harmless on their own. More serious but rarer causes include ventricular tachycardia (about 2% of cases) and structural heart problems (about 3%).
How Doctors Evaluate Palpitations
The challenge with palpitations is that they often come and go, so your heart may be behaving perfectly during an office visit. Doctors typically start with an electrocardiogram (ECG), a quick, painless test where sticky patches on your chest record the heart’s electrical activity. It can show whether the heart is beating too fast, too slow, or irregularly, but only captures what’s happening in that moment.
If the ECG looks normal but you’re still having episodes, you may be given a portable monitor to wear at home. A Holter monitor records continuously for one to two days. An event recorder stays on for up to 30 days and captures data only when you press a button during symptoms or when it detects an abnormal rhythm on its own. Some smartwatches now offer basic ECG monitoring that can help catch episodes between doctor visits.
If there’s concern about the heart’s structure, an echocardiogram uses sound waves to create a moving image of the heart, revealing valve problems, thickened walls, or other physical abnormalities that could explain the symptoms.
Physical Techniques to Calm a Racing Heart
Vagal maneuvers are simple physical actions that stimulate the vagus nerve, which acts as a brake on your heart rate. They have a 20% to 40% success rate for converting certain fast rhythms back to normal. You can try them at home when you feel an episode starting.
- 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. Hold for 10 to 30 seconds.
- Diving reflex: While sitting, take several deep breaths, hold your breath, and plunge your face into a bowl of ice water. Alternatively, press an ice-cold wet towel firmly against your face. The shock of cold activates a reflex that slows the heart.
- Coughing: A hard, sustained cough can briefly reset your heart’s rhythm through the same vagus nerve pathway.
These techniques work best for rhythms originating in the upper chambers of the heart. They won’t help with every type of palpitation, but they’re safe to try and can spare you an anxious trip to the emergency room.
Warning Signs That Need Immediate Attention
Most palpitations are harmless, but certain combinations of symptoms signal something more serious. Seek emergency care if palpitations occur alongside chest pain lasting more than a few minutes, fainting or near-fainting, or significant shortness of breath. These could indicate a dangerous arrhythmia, reduced blood flow to the heart, or another condition that requires urgent evaluation. Palpitations that happen repeatedly during physical exertion, or episodes that leave you feeling weak or confused, also warrant prompt medical attention.