What should you know about excessive heart palpitations?

Excessive heart palpitations are repeated or troublesome sensations of a racing, pounding, fluttering or irregular heartbeat; they are often harmless but need assessment when persistent, new or accompanied by warning symptoms. The sensation may happen when the heart rhythm is normal, or it may reflect an irregular rhythm. A clinician can help distinguish these possibilities from your symptoms, pulse and, when needed, heart testing.

Palpitations may be triggered by stress, anxiety, lack of sleep, strenuous activity, fever, caffeine, nicotine, alcohol or some medicines. Dehydration and low blood sugar can also make the heartbeat feel forceful or fast. Anaemia, including iron deficiency anaemia, can cause the heart to work harder to deliver oxygen. An overactive thyroid may increase the heart rate.

Atrial fibrillation is an irregular rhythm that can present with palpitations, while heart failure can present with palpitations alongside breathlessness, reduced exercise tolerance or swelling. These conditions are not diagnosed from the sensation alone, and a palpitation does not by itself show that you have one of them.

Arrange a medical appointment if the episodes keep returning, last longer than usual, are becoming more frequent, or interfere with daily activity. Record when each episode starts, how long it lasts, whether the rhythm feels regular or irregular, what you were doing, and any associated symptoms. Note caffeine, nicotine, alcohol, illness, new medicines and missed meals because these details can reveal a trigger.

Until you are assessed, drink fluids if you may be dehydrated, eat regular meals, sleep as well as possible and reduce stimulants that clearly bring on symptoms. Do not stop prescribed medicine without medical advice. A clinician may check your pulse, blood pressure, blood tests and an electrocardiogram; a wearable monitor may be useful when episodes come and go.

Seek emergency help if palpitations are happening with chest pain or pressure, severe breathlessness, fainting, near-fainting, marked dizziness, confusion, or sudden weakness on one side. Get urgent medical advice for a very fast or clearly irregular heartbeat that does not settle, especially if you have known heart disease or symptoms are new. Do not drive yourself if you feel faint or seriously unwell.

Ask what might be triggering the episodes, whether you need an electrocardiogram or rhythm monitor, and whether blood tests should check thyroid function, anaemia or glucose. Tell the clinician about fainting, breathlessness, chest discomfort, family history of rhythm problems and every medicine or supplement you take.