Palpitations

Overview

Palpitations are the sensation of being aware of your own heartbeat — it may feel too fast, too hard, irregular, or as though it is skipping or adding beats. They are extremely common and, in most people, are benign, brought on by adrenaline from anxiety or excitement, caffeine, nicotine, energy drinks, poor sleep, a feverish illness, dehydration or certain medicines. A smaller fraction point to a heart-rhythm problem such as atrial fibrillation or frequent ectopic beats, or to an underlying condition such as a thyroid disorder or anaemia. This is the main page for the symptom; specific patterns are explored on the linked pages below.

Common causes

• Benign triggers — anxiety, stress, caffeine, nicotine, energy drinks, poor sleep and dehydration.
• Ectopic (extra) beats — usually harmless skipped or added beats.
• Rhythm problems — including atrial fibrillation and supraventricular tachycardia.
• An over-active thyroid (hyperthyroidism).
• Anaemia and low haemoglobin.
• Fever and infection.
• Medication effects — inhalers, certain cold remedies, and thyroid or blood-pressure medicines.
• Electrolyte disturbances such as low potassium.
• Hormonal changes and pregnancy.

Symptoms and associated features

The hallmark is awareness of the heartbeat. The pattern guides the assessment: sudden onset and sudden offset of a very fast beat may suggest a rhythm problem; a fast beat that builds gradually with stress or illness is more often benign; a regularly irregular pattern with skipped beats suggests ectopics; and a persistently irregular pulse suggests atrial fibrillation. Features that raise concern are chest discomfort, dizziness, fainting or breathlessness with the palpitations.

Evaluation and investigations

Evaluation combines a careful history and examination with an ECG as the first test. Blood tests check for anaemia, thyroid function, electrolytes and blood sugar. When episodes come and go and the ECG is normal between them, an ambulatory ECG (Holter monitor) over 24 hours or longer is used to capture the rhythm during an episode. An echocardiogram is arranged when a structural heart problem is suspected. See ECG Evaluation for Symptoms and Abnormal Test Results.

Management overview

Management treats the cause. Benign triggers are managed by reducing caffeine, improving sleep, addressing stress and reassurance; ectopic beats in an otherwise normal heart often need no treatment; atrial fibrillation and other arrhythmias are managed with rate or rhythm control and stroke-risk assessment; an over-active thyroid is treated; anaemia is corrected; and medication-related palpitations are resolved by reviewing the prescription.

Follow-up and monitoring

Follow-up confirms the palpitations have settled and that any rhythm problem is controlled. Persistent or new features are reviewed and, where appropriate, referred for specialist cardiac assessment.

Warning signs — seek urgent care

• Palpitations with chest pain or tightness, sweating, or pain radiating to the arm or jaw — emergency.
• Palpitations with fainting or near-fainting — urgent.
• A very fast or irregular heartbeat with dizziness or breathlessness — urgent.
• Palpitations with collapse or loss of consciousness — emergency.

How we help

Dr. Nayak evaluates palpitations with a structured history, examination, an ECG and targeted blood tests, treats the underlying cause, and arranges a Holter monitor or cardiology referral where needed. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• Fast Heartbeat
• Irregular Heartbeat Sensation
• Skipped Heartbeat Sensation
• Awareness of Heartbeat
• ECG Evaluation for Symptoms
• Thyroid Disorders
• Anaemia & Blood Problems