Palpitations: when to worry
Palpitations are a common symptom experienced by many individuals at some point in their lives. They can feel alarming, but in most cases they are harmless. However, certain patterns of heart palpitations may indicate an underlying condition requiring medical attention.
In this guide, a consultant cardiologist article outlines what palpitations are, their common causes, and when to seek further assessment.
What are palpitations?
Palpitations refer to an increased awareness of the heartbeat. They are often described as a sensation of the heart racing, fluttering, skipping beats, or pounding in the chest. These sensations may occur at rest or during activity and can last from a few seconds to several minutes.
Importantly, palpitations are a symptom rather than a diagnosis and may arise from a variety of causes.
Common causes of palpitations
Many cases of palpitations are linked to benign or lifestyle-related factors. Common triggers include caffeine, alcohol and smoking. Emotional factors such as stress or anxiety, along with poor sleep, are also well-recognised contributors.
Medical causes
Certain medical conditions can also lead to heart palpitations, such as:
Heart rhythm disturbances
Some palpitations are caused by abnormalities in the heart’s electrical system, known as arrhythmias. Common examples include:
- Premature beats (extra or skipped beats).
- Supraventricular tachycardia (SVT).
- Atrial fibrillation.
While many arrhythmias are not dangerous, some require further evaluation and management.
When should you worry about palpitations?
Medical attention should be sought if palpitations are accompanied by:
- Chest pain or discomfort.
- Shortness of breath.
- Dizziness or light-headedness.
- Fainting (syncope).
These features may suggest a more serious underlying heart condition.
Frequency and duration
Further assessment is recommended if palpitations are persistent or recurrent, increasing in frequency, or prolonged in duration.
Personal and family history
Assessment is also advisable for individuals who:
- Have a history of heart disease.
- Have a family history of sudden cardiac death.
- Take medications that may affect heart rhythm.
How are palpitations assessed?
Evaluation of palpitations typically begins with a detailed clinical history and physical examination. Investigations may include an electrocardiogram (ECG), a Holter monitor for continuous heart rhythm recording, blood tests to assess for anaemia or thyroid dysfunction, and an echocardiogram to evaluate heart structure and function.
These tests help determine whether palpitations are benign or require treatment.
Managing palpitations
In many cases, palpitations can be managed with lifestyle modifications, including reducing caffeine and alcohol intake, managing stress effectively, and improving sleep quality.
Medical treatment
If an arrhythmia is identified, treatment options may include medication to control heart rhythm or procedures such as catheter ablation in selected cases.
Palpitations are frequently benign but should not be ignored, particularly when associated with concerning symptoms or risk factors. Appropriate assessment can provide reassurance for many individuals while identifying those who may require treatment. Seeking timely medical advice ensures both safety and peace of mind.