Palpitations: a complete guide

Heart palpitations refer to the sensation of your heart beating irregularly, too quickly, or with unusual force. While typically benign, in some cases palpitations can signal a more serious underlying condition.

In this article, a consultant cardiologist explains the possible causes, likely symptoms, and when patients should seek medical attention.

What are common causes of heart palpitations?

Heart palpitations can arise from various causes, including:

Lifestyle factors

Stress and anxiety stimulate the release of adrenaline, leading to an increased heart rate or irregular beats.
Caffeine, nicotine, and alcohol stimulate and irritate the heart, triggering palpitations.
Physical exercise temporarily increases your heart rate, which can result in palpitations.

Medical conditions

Arrhythmias, such as atrial fibrillation and premature ventricular contractions, can cause palpitations.
Structural heart issues, such as valve disorders and cardiomyopathy, can lead to the occurrence of palpitations.
Disorders like hyperthyroidism, anaemia, or low blood sugar levels can trigger palpitations as a result of metabolic changes.
Menstruation, pregnancy, and the menopause can alter hormone levels, which can occasionally result in palpitations.

Certain medications, including decongestants, asthma inhalers, or thyroid treatments, can also have side effects that affect heart rhythm.

What symptoms are associated with heart palpitations?

Heart palpitations are typically experienced as an unusual awareness of the heartbeat. Some people may describe this as a fluttering, pounding, or racing sensation in the chest, while others might feel skipped beats or a brief pause followed by a strong thud.

In addition to the palpitations themselves, some people may also experience accompanying symptoms such as light-headedness or dizziness, fatigue, and chest pain. Shortness of breath, excessive sweating, and fainting could indicate a heart attack and should be treated as a medical emergency.

When should I seek medical attention for heart palpitations?

Not all heart palpitations are cause for concern. For many people, palpitations are temporary and linked to a clear cause, such as stress. Despite this, certain situations require prompt medical attention.

Patients should seek medical attention if:

The palpitations occur frequently, last for more than a few minutes, or worsen over time.
The palpitations are accompanied by severe symptoms.
They have a history of heart disease or risk factors, such as high blood pressure or diabetes.

How are heart palpitations treated?

Treatment for palpitations depends on the underlying cause. In many cases, lifestyle modifications, such as reducing caffeine intake, stress management, or improving hydration, may suffice.

Your cardiologist will recommend various diagnostic tests to identify the cause of the palpitations:

Electrocardiogram (ECG): This test monitors the heart’s electrical activity to detect irregular rhythms.
Holter monitor: This portable device tracks heart rhythms over 24-28 hours or longer to detect palpitations that occur intermittently.
Echocardiogram: This is an ultrasound of the heart that assesses its structure and function.

In some cases, stress testing will be conducted to evaluate the heart’s response to physical activity. Blood tests may also be performed to rule out thyroid disorders, anaemia, or other systemic conditions.

For more severe cases, interventions may include:

Medications such as beta-blockers or antiarrhythmic drugs to control heart rhythm.
Surgical procedures like catheter ablation to correct abnormal electrical pathways, or the implantation of a pacemaker for severe rhythm disturbances.