What should you know about breathing palpitations?

Palpitations may happen after exertion, emotional stress, poor sleep, caffeine or nicotine. Dehydration, low blood sugar and anaemia can also make the heartbeat feel more noticeable. Hyperthyroidism can drive a faster pulse. Atrial fibrillation is an irregular rhythm that may cause a fluttering sensation, breathlessness or reduced exercise tolerance. Heart failure can cause breathlessness and a fast heartbeat, particularly with activity or when lying down. Generalised anxiety disorder can cause physical symptoms such as a racing heart and rapid breathing, but anxiety should not be assumed before other causes are considered.

The sensation does not reveal the rhythm by itself. The duration, regularity, trigger, pulse pattern and symptoms such as dizziness or chest discomfort help guide evaluation.

Stop strenuous activity and sit somewhere safe. Breathe slowly and normally rather than forcing deep breaths. If you can, record when the episode began, how long it lasted, whether the rhythm felt regular, and what you were doing beforehand. Avoid extra caffeine, nicotine and stimulant products until you have been assessed. Drink fluids if you may be dehydrated and can safely do so. Arrange a medical review for new, recurrent or prolonged palpitations; an examination, pulse check and heart tracing may help identify the cause. Do not take someone else’s heart medicine.

Call emergency services for palpitations with chest pain, severe breathlessness, fainting, collapse, confusion, or marked weakness. Seek urgent assessment if the heartbeat remains very fast or irregular, symptoms begin during exertion, or you have known heart disease. A first episode accompanied by significant breathing difficulty should not be dismissed as stress. If symptoms settle but keep returning, arrange prompt clinical review and bring any pulse or symptom notes.

Ask: Does my pulse feel regular or irregular? Could dehydration, anaemia, thyroid disease or low blood sugar be contributing? Do I need an ECG or a monitor? Which symptoms mean I should call emergency services? What should I do if the sensation returns?