Most heart palpitations are harmless and resolve on their own within seconds or minutes. In studies of patients presenting with palpitations, roughly 31% trace back to stress or anxiety, while only about 3% involve structural heart problems. That said, knowing what steps to take, both in the moment and longer term, can help you feel more in control and catch the rare cases that need medical attention.
What’s Actually Happening in Your Chest
A palpitation is the sensation of your heart beating in a way you wouldn’t normally notice. It might feel like a flutter, a skipped beat, a sudden thump, or a racing pulse. The most common cause is a premature heartbeat, where the heart fires an extra beat slightly earlier than expected, followed by a pause and then a stronger-than-usual beat. That stronger beat is what you feel. These extra beats can originate in the upper chambers or the lower chambers of the heart, and both types are usually benign.
Other causes include a temporary increase in heart rate from stress hormones, caffeine, or physical exertion. In some cases, the heart’s electrical system briefly misfires in a way that produces a sustained fast rhythm, such as atrial fibrillation (an irregular rhythm starting in the upper chambers). About 16% of palpitation cases involve atrial fibrillation, and another 10% involve other types of fast rhythms that originate above the lower chambers.
What to Do in the Moment
If you feel palpitations starting, try these steps:
- Slow your breathing. Sit or lie down, and take slow, deep breaths in through your nose and out through your mouth. This activates the vagus nerve, which helps slow your heart rate.
- Try the Valsalva maneuver. Bear down as if you’re having a bowel movement, and hold for 10 to 15 seconds. This increases pressure in your chest and stimulates the vagus nerve. A modified version involves bearing down while lying flat, then bringing your knees to your chest and holding that position for 30 to 45 seconds. For children, blowing hard on a thumb without letting air escape works the same way.
- Splash cold water on your face. The cold triggers a reflex that slows the heart. Holding a bag of ice against your face for a few seconds has a similar effect.
- Cough forcefully. A hard cough creates a brief spike in chest pressure that can interrupt an abnormal rhythm.
These vagal maneuvers work best for palpitations caused by fast rhythms originating in the upper part of the heart. They won’t fix every type of palpitation, but they’re safe to try and often bring relief within seconds.
Common Triggers Worth Tracking
Many palpitations have a clear trigger. Identifying yours is one of the most useful things you can do, because removing the trigger often eliminates the problem entirely.
Caffeine is the trigger people think of first, and for good reason. It’s a stimulant found in coffee, tea, energy drinks, soda, and chocolate. Research suggests that up to three cups of coffee per day is generally fine for most people, and may even have heart benefits. Beyond that threshold, palpitations become more common. If you’re sensitive, even one cup could be enough.
Alcohol is another frequent culprit. It can directly trigger atrial fibrillation, even in people with otherwise healthy hearts. The effect is dose-dependent: the more you drink, the higher the risk.
Certain foods can also play a role. High-sugar and high-carbohydrate meals can spike blood sugar, especially if you’re prone to low blood sugar, and trigger a racing heart in response. Spicy or rich foods sometimes cause palpitations indirectly by provoking acid reflux. Aged cheeses, cured meats, and dried fruit contain tyramine, an amino acid that raises blood pressure and can cause palpitations. Chocolate contains a compound called theobromine that increases heart rate. MSG, a flavor enhancer in some processed and restaurant foods, triggers palpitations in sensitive individuals.
Supplements are an underappreciated trigger. Bitter orange, ephedra, ginseng, hawthorn, and valerian have all been linked to palpitations, particularly when taken with meals.
Keeping a simple log of when your palpitations happen, what you ate or drank beforehand, your stress level, and how much sleep you got the night before can reveal patterns within a week or two.
Medications That Can Cause Palpitations
Several common medications list palpitations as a side effect. Asthma inhalers that contain bronchodilators (like albuterol) stimulate the same receptors that adrenaline does, and can make your heart race. Nasal decongestants work similarly. Stimulant medications used for ADHD can also increase heart rate and trigger palpitations. Even some heart medications, paradoxically, can worsen certain rhythms.
If your palpitations started or worsened after beginning a new medication, that connection is worth raising with your prescriber. Don’t stop a prescribed medication on your own, but do flag the timing.
When Palpitations Are Anxiety, Not Your Heart
Nearly a third of all palpitation cases are driven by stress or anxiety rather than a heart rhythm problem. Some people feel their heart pounding even when monitoring shows a completely normal rhythm. The sensation is real, but the cause is heightened awareness and nervous system activation rather than an electrical problem in the heart.
A few patterns can help you sort this out. Palpitations tied to anxiety tend to come with other anxiety symptoms: shallow breathing, sweating, a sense of dread, or tingling in the hands. They often happen during or right after a stressful moment, and they resolve within a few minutes as the stress passes. Palpitations that happen frequently regardless of your emotional state, last more than a few minutes, or come with physical symptoms like dizziness or chest pain are more likely to have a cardiac cause and deserve a medical evaluation.
How Doctors Evaluate Palpitations
If you see a doctor about palpitations, the evaluation typically starts with a physical exam, a listen to your heart with a stethoscope, and questions about your medical history, symptoms, and any substances you use. Sometimes the story alone is enough to make a diagnosis.
Blood tests are common next steps. These check for anemia, low potassium, and thyroid problems, all of which can cause palpitations and are easy to treat once identified. An electrocardiogram (ECG) records your heart’s electrical activity during the visit, but since palpitations are often intermittent, a normal ECG doesn’t rule everything out.
If your ECG is normal but symptoms continue, your doctor may have you wear a Holter monitor, a small portable device that records your heart rhythm continuously for a day or more while you go about your normal routine. This captures episodes that a brief office ECG would miss. An echocardiogram, which uses ultrasound to create a moving image of your heart, may be ordered to check the structure and blood flow if there’s any concern about an underlying heart condition.
When Palpitations Are an Emergency
Most palpitations don’t require a trip to the emergency room, but a few combinations of symptoms do. Seek immediate care if palpitations occur alongside:
- Sudden collapse or loss of consciousness. This suggests the heart rhythm is unstable enough to reduce blood flow to the brain.
- Chest pain. This combination could indicate a serious arrhythmia or a problem with blood supply to the heart.
- A racing heart with dizziness or lightheadedness. Feeling like you might faint while your heart is racing means your brain isn’t getting adequate blood flow.
- Trouble breathing or confusion. Either symptom alongside sustained palpitations warrants emergency evaluation.
Palpitations that go away on their own within a few seconds and aren’t accompanied by any of these symptoms are far less concerning. But palpitations that come back often, last longer than a few minutes, or feel different from your usual experience are worth getting checked, even if they don’t meet the emergency criteria above. The goal isn’t to panic, but to get enough information so you and your doctor can confidently identify the cause and decide whether it needs treatment.