What should you know about frequent heart palpitations?

Palpitations may feel like pounding, fluttering, skipped beats or a racing heart. They can occur after exertion, during anxiety, with poor sleep, fever, nicotine or stimulant medicines. Dehydration and low blood sugar can also make the heartbeat feel more noticeable.

Anaemia and iron deficiency anaemia can present with a fast or forceful heartbeat because the body is working harder to deliver oxygen. An overactive thyroid can do the same. A rhythm problem such as atrial fibrillation may cause an irregular pulse, while heart failure is more often accompanied by breathlessness, swelling or reduced exercise tolerance. These conditions are possibilities, not conclusions from the symptom alone.

Keep a simple record of when each episode starts, how long it lasts, whether the rhythm feels regular, what you were doing, and any drinks or medicines taken beforehand. Reduce caffeine, nicotine and other stimulants, drink fluids regularly, and avoid skipping meals. Do not stop prescribed medicine without advice.

A clinician may check your pulse, blood pressure, medication list and an electrocardiogram. Blood tests can look for anaemia, iron deficiency, thyroid changes or glucose problems; a portable monitor may be useful when episodes come and go.

Seek emergency help if palpitations occur with chest pain, severe breathlessness, fainting, new confusion or marked weakness, or if a very fast or irregular heartbeat does not settle. Arrange prompt medical review when episodes are becoming more frequent, occur with dizziness, or begin during exercise. Bring your symptom record and medicine list to the appointment.

Could my symptoms be related to anaemia, thyroid activity, dehydration or a rhythm change? Do I need an electrocardiogram, blood tests or a wearable monitor? Which activities, drinks or medicines should I avoid while this is being assessed?