Palpitations: when should you worry about an irregular heartbeat?

Palpitations are sensations of feeling your heartbeat, and although they are often harmless, they can sometimes indicate an abnormal heart rhythm that needs medical assessment. They may feel like pounding, fluttering, racing or skipped beats and can occur at rest or during activity.

What causes palpitations?

Palpitations can be caused by everyday factors, lifestyle habits or an underlying heart rhythm problem.

Common triggers and causes include:

• Stress, anxiety or panic attacks.
• Caffeine, alcohol or nicotine.
• Lack of sleep, dehydration or strenuous exercise.
• Certain medicines, including some asthma and cold remedies.
• Hormonal changes, including during the menopause.
• Abnormal heart rhythms, such as atrial fibrillation or supraventricular tachycardia.
• Heart conditions affecting the heart muscle, valves or coronary arteries.

Occasional palpitations without other symptoms are usually not a sign of a serious problem. However, recurrent or persistent symptoms should be assessed, particularly if there are cardiovascular risk factors or a known heart condition.

What do heart palpitations feel like?

Palpitations can feel different from person to person, but they commonly create a noticeable awareness of the heartbeat. Some people describe the sensation as a fluttering or pounding in the chest, while others feel as though the heart is racing or missing a beat.

Other symptoms can occur alongside palpitations, including:

• A rapid or irregular heartbeat.
• A fluttering sensation in the chest or neck.
• Dizziness or light-headedness.
• Shortness of breath.
• Chest discomfort.
• Tiredness or weakness.

The duration and circumstances of the symptoms are also important. Keeping a record of when palpitations occur, how long they last and whether they are associated with exercise or other symptoms can help with medical assessment.

When should an irregular heartbeat be concerning?

An irregular heartbeat should be assessed urgently when it occurs with symptoms such as chest pain, severe breathlessness, fainting or significant dizziness. These symptoms can indicate a potentially serious heart problem and should not be ignored.

Palpitations that repeatedly occur during exercise, become more frequent, last for prolonged periods or are associated with a very fast heartbeat also warrant medical assessment. A family history of sudden cardiac death or a known heart condition can further increase the importance of prompt evaluation.

How are palpitations diagnosed?

Palpitations are usually investigated with an assessment of the symptoms, medical history and heart rhythm, often beginning with an electrocardiogram (ECG). An ECG records the heart's electrical activity and can identify several types of abnormal rhythm.

If palpitations are intermittent, they may not occur during a standard ECG. In these circumstances, longer-term monitoring may be recommended using a portable device worn for 24 hours or longer. Blood tests may also be used to look for contributing problems, such as thyroid disorders or anaemia.

How are palpitations treated?

Treatment for palpitations depends on their underlying cause, and some people do not require specific treatment. Where an identifiable trigger is responsible, reducing caffeine or alcohol, improving sleep and maintaining adequate hydration may help reduce episodes.

When an abnormal heart rhythm is diagnosed, treatment may include:

• Medicines to control the heart rate or rhythm.
• Anticoagulant medication for some people with atrial fibrillation to reduce stroke risk.
• Cardioversion to restore a normal heart rhythm in appropriate cases.
• Catheter ablation to treat certain recurrent abnormal rhythms.
• Treatment of an underlying heart or thyroid condition.

The appropriate approach depends on the specific rhythm, symptoms, overall cardiovascular health and individual risk factors.

If you are experiencing recurrent palpitations or are concerned about an irregular heartbeat, visit Dr Fairoz Abdul’s Top Doctors profile to book a consultation.

References

• NHS. Heart palpitations.
• NICE. Atrial fibrillation: diagnosis and management (NG196).
• National Institute for Health and Care Excellence. Tachycardia: assessment and management.
• National Institute for Health and Care Excellence. Palpitations and arrhythmias: clinical assessment.
• Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal.