What is Heart Palpitations: When to Worry?

A guide to understanding heart palpitations — common causes, when to seek help, and what tests may be done.

Heart & Circulation

Heart Palpitations: When to Worry

2025-09-08 • Updated 2025-09-18

Intro

Heart palpitations are the sensation of your heart racing, pounding, skipping beats, or fluttering. They are common and often harmless, but in some cases they may signal a heart rhythm problem that requires medical attention.

Key Points

Palpitations are usually caused by anxiety, caffeine, or stimulants.
They can also be linked to thyroid problems, anemia, or heart rhythm disorders.
Simple tests like an ECG or Holter monitor can help find the cause.
Most cases are harmless and improve with lifestyle changes.

🚨 Red Flags

Seek urgent medical help if palpitations occur with:

Chest pain or pressure
Fainting or near-fainting
Severe shortness of breath
Dizziness or confusion
Palpitations lasting longer than a few minutes without relief

✅ Reassurance

Most palpitations are benign and self-limiting.
They often come from everyday triggers like stress, caffeine, or lack of sleep.
If you are otherwise healthy, palpitations are rarely dangerous.

Background

Your heartbeat is controlled by the heart’s electrical system. Anything that alters this rhythm — from stress hormones to caffeine to structural heart disease — can cause palpitations. Most people experience them at some point in their lives.

Causes or Risk Factors

Lifestyle/benign: stress, anxiety, caffeine, alcohol, nicotine, dehydration, lack of sleep.
Medical conditions: thyroid disease, anemia, pregnancy, fever, electrolyte imbalance.
Heart rhythm disorders: atrial fibrillation, supraventricular tachycardia (SVT), ventricular arrhythmias.
Medications and substances: decongestants, asthma inhalers, stimulants, recreational drugs.

Diagnosis and Treatment

Initial evaluation: history, physical exam, and ECG.
Monitoring: Holter (24–48h) or event monitors to catch intermittent episodes.
Blood tests: thyroid, blood count, electrolytes.
Treatment: depends on cause. For most people, reducing triggers (caffeine, stress, alcohol) is enough.
Serious arrhythmias: may need medications, procedures (ablation), or devices (pacemaker/defibrillator).

Risks and Prognosis

Most palpitations are harmless.
Risk rises if associated with heart disease, family history of sudden cardiac death, or abnormal ECG.
With proper diagnosis, most rhythm disorders can be well controlled.

FAQ

Q: Should I see a doctor if my heart races during exercise?
A: A faster heartbeat during exertion is normal. If it feels irregular, causes chest pain, or makes you faint, see a doctor.

Q: Can anxiety really cause palpitations?
A: Yes. Stress hormones trigger the heart to beat faster and stronger. This is one of the most common causes.

Q: What tests should I expect?
A: Usually an ECG first, sometimes a Holter monitor, blood tests, and rarely an echocardiogram.

Q: Are palpitations dangerous in young healthy people?
A: Usually not. They are often due to lifestyle triggers and resolve with reassurance and lifestyle changes.

Q: When are palpitations a medical emergency?
A: If they come with chest pain, fainting, severe shortness of breath, or last more than a few minutes, call emergency services.