Palpitations: When Your Heart Feels Different

Palpitations may feel like pounding, fluttering, racing or skipped beats in the chest, neck or throat. The sensation cannot reveal the rhythm by itself. Some patterns need emergency help, while many others can be assessed routinely.

Palpitations describe a sensation Palpitations are an unusual or uncomfortable awareness of your heartbeat. You may feel pounding, fluttering, racing, extra beats or apparent pauses in your chest, neck or throat. The sensation does not prove that the heart rhythm is abnormal. Some people notice palpitations during normal sinus rhythm, especially when the heart beats faster or more forcefully. An arrhythmia is a problem with the heart's rate or rhythm. It may be too fast, too slow or irregular. Palpitations can occur with an arrhythmia, but the two terms do not mean the same thing. How descriptions provide clues Clinicians ask whether the feeling is fast, irregular, pounding or like a skipped beat. They also ask whether it begins suddenly, builds gradually, lasts seconds or continues longer. These descriptions can guide the next questions, but they cannot identify the rhythm reliably. Different rhythms can feel similar, and the same rhythm can feel different between people. A feeling of a skipped beat may occur with an ectopic beat. This is an early heartbeat arising outside the heart's usual pacemaker. The following beat may feel stronger, but the sensation alone cannot confirm this pattern. Several mechanisms can cause palpitations Normal responses can make the heartbeat more noticeable. Exercise, stress, anxiety, lack of sleep, fever, dehydration and hormonal changes can all contribute. Caffeine, nicotine, alcohol, recreational drugs and some medicines can also trigger symptoms. Do not stop prescribed medicine without medical advice. Medical conditions such as iron deficiency anaemia or an overactive thyroid can increase the heart rate or make beating feel stronger. Pregnancy and menopause can also be associated with palpitations. Rhythm causes include ectopic beats, atrial fibrillation and other fast or slow arrhythmias. Sinus tachycardia means a faster rate produced through the heart's usual pacemaker pathway. It can be a normal response or reflect another condition. Anxiety can produce real physical palpitations. However, an emotional trigger does not prove that anxiety is the cause, especially when symptoms are new, changing or accompanied by concerning features. The surrounding pattern matters Duration, frequency and context help shape the assessment. Clinicians ask whether episodes occur at rest, during physical activity, after standing, during illness or after taking a substance or medicine. They ask about chest pain, breathlessness, dizziness, feeling faint and fainting. They also consider previous heart disease, health problems in the family, pregnancy, bleeding, thyroid symptoms and recent illness. Palpitations during physical activity, recurrent fainting or a sudden cardiac death can increase concern in the family. These details require professional assessment rather than self diagnosis. Examination gives clues, not a rhythm diagnosis A clinician checks the pulse rate and whether it feels regular or irregular. They may also measure blood pressure, breathing rate, oxygen saturation and temperature. An irregular pulse raises suspicion of atrial fibrillation, ectopic beats or another rhythm disturbance. It does not confirm which rhythm is present. A regular pulse during the appointment does not exclude an intermittent arrhythmia. The episode may have stopped before the examination. The clinician may listen for heart sounds or a murmur and look for signs of anaemia, thyroid disease or fluid accumulation. Findings are interpreted with the person's symptoms and background and tests. An ECG records the electrical pattern An ECG records the heart's electrical activity during the test. It can identify many fast, slow or irregular rhythms if they are present while the recording is made. NICE recommends a 12 lead ECG to diagnose atrial fibrillation when an irregular pulse is detected and atrial fibrillation is suspected. Pulse examination alone is not enough. A normal ECG between episodes does not exclude an intermittent arrhythmia. It only shows the electrical pattern during that recording. An ambulatory ECG monitor records the rhythm for longer while you continue normal activities. The monitoring period is chosen partly according to how often symptoms occur. A symptom diary can help match the recorded rhythm with what you felt and what you were doing. This can show whether symptoms coincide with an arrhythmia or another rhythm. Blood tests may check for anaemia, thyroid disease or disturbances in electrolytes. Other investigations depend on what the person describes, the examination and ECG findings. Atrial fibrillation is one possible rhythm Atrial fibrillation is an arrhythmia with disorganised electrical activity in the upper chambers. The pulse is often irregular, but an ECG is required to confirm the diagnosis. Confirmed atrial fibrillation matters because management may include controlling the rate or rhythm and assessing stroke risk. Those decisions belong after the rhythm has been recorded and reviewed. What may happen after assessment Brief palpitations without concerning features may not require treatment. Clinicians may discuss sleep, caffeine, alcohol, nicotine, medicines or other possible contributors. Recurrent, worsening or longer episodes may need an ECG, ambulatory monitoring or further assessment. The plan depends on the complete pattern rather than one trigger or description. When to get help Call 999 or go to A&E if you currently have palpitations that do not go away. Also call 999 if they occur with chest pain, shortness of breath, feeling faint or fainting. Do not drive yourself to A&E. If these associated symptoms have stopped, seek urgent advice from your GP surgery or NHS 111. Arrange a GP review if palpitations keep returning, become more frequent or last longer than a few minutes. Review is also important with existing heart disease or a heart problems in the family. This lesson cannot identify the cause of an individual episode. It explains why symptoms, pulse findings and ECG recordings must be interpreted together.

Palpitations are a symptom of heartbeat awareness, not proof of an arrhythmia. A pulse gives clues, while an ECG or ambulatory monitor records the electrical pattern needed to identify a rhythm.