Understanding palpitations: when should you worry?

Palpitations are a common symptom that many people experience at some point in their lives. They can feel unsettling, but are not always a sign of a serious heart condition.

In this guide, Dr Salam Salloum, a professional in cardiovascular medicine explains what heart palpitations are, their common causes, when they may be a cause for concern, and when it is advisable to seek medical advice.

What are palpitations?

Palpitations refer to an increased awareness of your heartbeat. They may feel like the heart is racing, fluttering, pounding, or skipping beats. These sensations can occur at rest or during activity and may last for a few seconds or several minutes.

In most cases, palpitations are harmless, particularly when they are infrequent and settle quickly.

Common causes of palpitations

Many episodes of palpitations are linked to everyday factors, including:

• Stress or anxiety.
• Caffeine or alcohol intake.
• Smoking.
• Lack of sleep.

These triggers can temporarily affect the heart rhythm, leading to noticeable changes in the heartbeat.

Medical causes

In some cases, palpitations may be related to underlying conditions, such as:

• Arrhythmias (abnormal heart rhythms).
• Thyroid disorders.
• Anaemia.
• Hormonal changes (including pregnancy or menopause).

Identifying the cause is important in determining whether further treatment is required.

When are palpitations harmless?

Palpitations are usually considered benign when they occur occasionally, last for a short duration, and have an identifiable trigger such as stress or caffeine. They are also less concerning when they are not associated with other symptoms. In these situations, simple lifestyle changes are often sufficient to manage or resolve symptoms.

When should you worry about palpitations?

Medical advice should be sought if palpitations are frequent or persistent, occur without a clear trigger, or appear to be increasing in intensity or duration over time. 

Symptoms that need urgent attention

Urgent assessment is required if palpitations are accompanied by:

• Chest pain or discomfort.
• Shortness of breath.
• Dizziness or light-headedness.
• Fainting (blackouts).

These symptoms may indicate a more serious heart problem and should not be ignored.

How are palpitations diagnosed?

Assessment typically begins with a review of symptoms, medical history, and lifestyle factors. Further investigations may include an electrocardiogram (ECG) to assess the heart rhythm, a Holter monitor which is a portable ECG worn over 24 to 48 hours, and blood tests to identify any underlying conditions.

These tests help determine whether the palpitations are benign or require treatment.

How can palpitations be managed?

Simple adjustments can significantly reduce palpitations:

• Limiting caffeine and alcohol.
• Managing stress.
• Maintaining good sleep habits.
• Stopping smoking.

Medical treatment

If an underlying condition is identified, treatment will be tailored accordingly. This may include medication or specialist procedures to treat arrhythmias.

Palpitations are a common symptom and are often harmless. However, recognising warning signs and associated symptoms is essential in identifying when they may indicate a more serious heart condition. Seeking timely medical advice ensures appropriate evaluation and peace of mind.