ECG and palpitations: what you should know

Palpitations are sensations such as pounding, fluttering, racing, or skipped beats. They can happen with stress, poor sleep, strenuous activity, caffeine, nicotine, alcohol, fever, or some medicines. Dehydration, low blood glucose, anaemia, iron-deficiency anaemia, and an overactive thyroid can also contribute.

An ECG uses sticky sensors on the chest and limbs to create a short tracing of the heart’s electrical activity. It can show the rate and rhythm during the recording and may identify an irregular rhythm such as atrial fibrillation. If symptoms are intermittent, a clinician may discuss a longer period of rhythm monitoring. The test itself does not send electricity into your body.

Arrange a medical assessment if palpitations are new, recurrent, becoming more frequent, or troubling you. Before the appointment, note when an episode begins, how long it lasts, whether the rhythm feels regular or uneven, what you were doing, and any symptoms alongside it. Bring a list of medicines, supplements, energy drinks, and other stimulants. Do not stop prescribed treatment without medical advice.

A clinician may check your pulse and blood pressure, perform an ECG, and consider blood tests or longer monitoring according to your symptoms and examination. The next step depends on the rhythm recorded and possible contributors, rather than on the sensation alone.

Seek emergency help if palpitations are accompanied by chest pain or pressure, severe shortness of breath, fainting, near-fainting, marked dizziness, confusion, or new weakness. Seek prompt assessment if a fast or irregular heartbeat continues and does not settle, particularly if you have known heart disease or feel significantly unwell. Do not drive yourself if you may faint or are seriously unwell.

Ask: Could my symptoms be caused by a rhythm problem or another medical condition? Was the ECG recorded during an episode? Would longer monitoring help? Which medicines, supplements, or drinks should I review? What warning signs mean I should seek emergency help?