Heart palpitations feel like your heart is skipping a beat, fluttering, pounding, or racing, and they’re one of the most common reasons people search for health information. The vast majority of palpitations are harmless, caused by something your body is reacting to rather than a problem with your heart itself. But understanding what’s behind them, and knowing which sensations deserve attention, can make the difference between unnecessary worry and catching something that matters.
What You’re Actually Feeling
The “skipped beat” sensation that most people describe is usually a premature ventricular contraction, or PVC. This is an extra heartbeat that fires just before your regular heartbeat. Because of that early beat, there’s a slightly longer pause before the next normal one. During that pause, your heart fills with more blood than usual, so the next beat is stronger. Interestingly, the beat you notice isn’t the extra one. It’s the forceful beat that follows the pause. Your heart didn’t actually skip anything. It just squeezed harder than expected, and your chest wall picked up on it.
Some people feel palpitations as a rapid fluttering, a pounding in the neck, or a general sense that their heart is working too hard. In all cases, the sensation comes from abnormal movement of the heart within the chest. Some people are simply more tuned in to their own heartbeat than others, and they notice normal changes in rate or rhythm that most people filter out, especially during exercise, illness, or stress.
Common Triggers You Can Control
Caffeine is one of the most widely recognized palpitation triggers. It blocks a chemical in your body that normally helps keep your heart rhythm steady, and it also increases the force of each heartbeat. People vary widely in their sensitivity, so a dose that’s fine for one person may cause noticeable fluttering in another. If you’ve recently increased your coffee, energy drink, or pre-workout intake, that’s a good place to start investigating.
Alcohol is another major trigger. Binge drinking, typically five or more drinks in a sitting, can cause a pattern sometimes called “holiday heart syndrome,” where the heart races or beats irregularly for hours or even days afterward. But even moderate drinking can provoke palpitations in sensitive individuals. Nicotine, whether from cigarettes or vaping, stimulates your nervous system in a similar way and can push your heart rate up or trigger extra beats.
Poor sleep and dehydration are easy to overlook. When you’re sleep-deprived, your body runs on higher levels of stress hormones, which increase heart rate and contractility. Dehydration reduces blood volume, forcing the heart to beat faster and harder to maintain circulation. Both can produce palpitations that seem to come out of nowhere.
Stress and Anxiety Play a Real Role
Anxiety doesn’t just make you more aware of your heartbeat. It physically changes how your heart behaves. When your body’s fight-or-flight system activates, it releases adrenaline, which increases both the rate and force of your heartbeat. This can trigger PVCs, speed up your resting heart rate, and create a feedback loop where noticing palpitations makes you more anxious, which makes the palpitations worse.
This is one of the most frustrating causes because the palpitations are completely real, not imagined, yet the underlying problem isn’t in the heart. If your palpitations tend to show up during periods of high stress, at night when you’re lying quietly with nothing to distract you, or during panic attacks, anxiety is a likely contributor.
Medical Conditions That Cause Palpitations
An overactive thyroid gland is one of the most important non-cardiac causes. When your thyroid produces too much hormone, it supercharges your metabolism and can increase the heart’s output by 50% to 300% above normal. This leads to a persistently fast heart rate, pounding sensations, shortness of breath during exercise, and sometimes an irregular rhythm called atrial fibrillation. If your palpitations come with unexplained weight loss, heat intolerance, or trembling hands, thyroid function is worth checking.
Iron-deficiency anemia is another common culprit, especially in women with heavy periods or people with poor dietary iron intake. When your blood can’t carry enough oxygen, your heart compensates by beating faster and harder, which you feel as pounding or racing. Fatigue, pale skin, and breathlessness with mild exertion are clues that anemia might be involved.
Low levels of potassium or magnesium can also make the heart’s electrical system more irritable, leading to extra beats or irregular rhythms. These electrolyte shifts can happen from heavy sweating, prolonged vomiting or diarrhea, or certain medications like diuretics (water pills).
Medications That Can Trigger Palpitations
Several common medications are known to affect heart rhythm. Asthma inhalers, particularly rescue inhalers containing drugs that open the airways, work by stimulating the same receptors that adrenaline does. That means they can speed up your heart or trigger extra beats, especially at higher doses.
Over-the-counter decongestants found in cold and sinus medications stimulate your cardiovascular system and can cause noticeable palpitations. Some antidepressants, antipsychotics, certain antibiotics, and even anti-nausea medications have rhythm-altering effects. If your palpitations started around the same time as a new medication or a dose change, that timing is worth bringing up with whoever prescribed it.
PVCs vs. Atrial Fibrillation
Not all palpitations feel the same, and the pattern matters. PVCs typically feel like a single skipped beat followed by a flip-flop or thud in your chest. They come and go, often in isolation, and most people have at least a few per day without ever noticing. PVCs are almost always benign, though people who have more than about 10,000 per day (roughly 10% of all heartbeats) over a long period face a higher risk of weakening the heart muscle over time.
Atrial fibrillation feels different. Instead of isolated skips, you’ll notice a sustained period of rapid, irregular beating, often described as a bag of worms squirming in the chest. It can last minutes, hours, or become permanent. It commonly comes with shortness of breath, fatigue, dizziness, and sometimes chest pressure. Atrial fibrillation is a more serious condition because the irregular rhythm allows blood to pool in the heart’s upper chambers, raising the risk of blood clots and stroke.
When Palpitations Signal an Emergency
Most palpitations don’t require emergency care, but certain combinations of symptoms do. A sudden collapse or loss of consciousness alongside palpitations means calling emergency services immediately. Palpitations paired with dizziness or lightheadedness, especially if you feel like you might faint, also warrant an emergency visit. Chest pain occurring with a racing or irregular heartbeat is another clear signal to seek immediate help.
Palpitations that last for minutes at a time, happen frequently, are getting worse over weeks, or disrupt your ability to function are worth discussing with a doctor even if they aren’t emergencies. The same goes for palpitations during exercise, which can occasionally point to a structural or electrical heart issue that needs evaluation.
How Palpitations Are Diagnosed
The challenge with diagnosing palpitations is that they’re usually intermittent. A standard electrocardiogram (ECG) captures only about 10 seconds of heart activity, so it often misses the event entirely. For this reason, doctors rely on wearable monitors.
A Holter monitor records your heart rhythm continuously for 24 to 48 hours. It’s useful if your palpitations happen daily. But research comparing monitoring approaches found that a standard 24-hour Holter identified the cause of palpitations in only about 2% of patients. A longer-term event recorder, worn for two weeks, successfully captured the responsible rhythm in 89% of patients. The difference is significant. If your palpitations happen every few days rather than every few hours, a longer monitoring period dramatically increases the odds of catching what’s going on.
Beyond rhythm monitoring, your doctor will likely order blood work to check thyroid function, electrolyte levels, and red blood cell counts. These simple tests can quickly rule in or out some of the most common non-cardiac causes.
Reducing Palpitations on Your Own
If your palpitations are the common, benign type, lifestyle changes can make a noticeable difference. Cutting back on caffeine, alcohol, and nicotine is the most straightforward starting point. Staying well-hydrated, getting consistent sleep, and managing stress through regular exercise or relaxation techniques all reduce the frequency of extra beats.
Keeping a simple log of when your palpitations happen, what you were doing, what you consumed in the hours before, and how long they lasted can reveal patterns you’d otherwise miss. That record is also extremely useful if you end up seeing a doctor, since palpitations rarely perform on command during an office visit.