Palpitations & Abnormal Heart Rhythm
Palpitations are an awareness of your heartbeat as fast, pounding or irregular; many are harmless, but some come from rhythm problems such as atrial fibrillation that need treatment.
Feeling your own heartbeat
Most of the time we do not notice the heartbeat. Palpitations are when you suddenly feel it racing, thumping, fluttering or skipping. At rest, an adult heart usually beats about 60 to 100 times a minute in a regular rhythm, controlled by electrical signals. When those signals start from the wrong place or travel in a loop, the rhythm changes. This is called an arrhythmia.
Common rhythm problems
- Extra beats (ectopics): a missed or "jumping" beat. Very common and often harmless.
- SVT: sudden spells of a very fast, regular beat that start and stop abruptly.
- Atrial fibrillation (AF): an irregular, often fast rhythm that raises the risk of stroke because clots can form inside the heart.
- Ventricular arrhythmias: rhythms from the lower chambers that can be serious, especially in a weak heart.
Triggers and causes
Tea, coffee, energy drinks, alcohol, smoking, poor sleep, stress and anxiety, fever, anaemia, an overactive thyroid and some cough and cold medicines can all trigger palpitations. Underlying heart problems such as a previous heart attack, valve disease, high BP or heart failure make serious rhythms more likely.
Catching the rhythm
The most useful test is an ECG taken during the palpitations, so if you can, get one done while it is happening. A smartwatch ECG recording can also be shown to your doctor. A Holter monitor (24 hours or longer) or an event recorder catches spells that come and go. An echocardiogram checks the heart's structure, and blood tests check thyroid, haemoglobin and salts. Some patients are referred for an electrophysiology (EP) study.
Treatment depends on the rhythm
Harmless extra beats often need only reassurance and cutting down triggers. Medicines can slow the rate or control the rhythm, and AF often needs a blood thinner to lower stroke risk. Some rhythms can be treated with a catheter procedure called ablation. People at risk of life-threatening ventricular rhythms may be advised an ICD.
Go to the emergency if
palpitations come with fainting, chest pain or severe breathlessness, or a fast heartbeat does not settle. Call 108 and see the emergency page.
Diagnosis and treatment are decided only after examination by your doctor. This page is for understanding palpitations.
For understanding only — the right test or treatment is decided after examination.
