Frequent palpitations: causes and what to do

Frequent palpitations can be caused by stress, stimulants, dehydration, illness, anaemia, thyroid changes, medicines or an abnormal heart rhythm. Palpitations are the sensation of noticing your heartbeat; they may feel like pounding, fluttering, racing or skipped beats. The sensation alone cannot identify the cause. A clinician may need to consider the timing, rhythm, triggers, other symptoms, medical history and medicines before deciding whether tests are needed.

Emotional strain, panic, poor sleep, fever, pain and strenuous activity can make the heart beat more noticeably. Caffeine, nicotine, alcohol, energy drinks and some cold remedies or inhalers can also trigger episodes. Fluid loss from heat, sweating, vomiting or diarrhoea may contribute to dehydration. Low blood glucose can cause a racing or pounding heartbeat, particularly in people using diabetes medicines.

Medical causes can include anaemia, including iron deficiency anaemia, because the heart may beat faster to deliver oxygen. An overactive thyroid can increase the heart rate and cause tremor, sweating or weight loss. An electrical rhythm problem such as atrial fibrillation may produce an irregular heartbeat. Heart failure can cause breathlessness, tiredness or ankle swelling alongside palpitations, but palpitations have many causes and do not by themselves establish heart failure.

Keep a brief record of when each episode starts, how long it lasts, whether the beat feels regular or irregular, what you were doing, and any symptoms such as dizziness or breathlessness. Review recent changes in caffeine, nicotine, alcohol, supplements, prescribed medicines, sleep, stress and fluid intake. Do not stop a prescribed medicine without medical advice. Arrange a primary-care appointment if episodes keep returning, are becoming more frequent, happen at rest, or interfere with sleep or normal activities. Assessment may include checking your pulse and blood pressure, reviewing medicines, and arranging an electrocardiogram or blood tests when appropriate.

Seek emergency help if palpitations are accompanied by chest pain or pressure, severe breathlessness, fainting, near-fainting, new confusion, or marked weakness. Get urgent medical advice for a sustained racing or irregular heartbeat, especially if you have known heart disease or symptoms are worsening. Do not drive yourself if you feel faint or seriously unwell.

Ask whether your symptom pattern suggests an irregular rhythm, whether an electrocardiogram or wearable monitor would help, and whether blood tests should check for anaemia, iron deficiency, thyroid changes or low glucose. Mention any family history of heart rhythm problems, fainting or sudden cardiac death, and bring your medicine and supplement list.