What should you know about hand palpitations?

Although the word hand appears in the question, palpitations are generally felt as a heartbeat sensation in the chest, throat or neck; some people may also notice an unusual pulse in a hand or wrist. The sensation may last moments or longer and may happen at rest or during activity.

Temporary triggers include stress, anxiety, poor sleep, strenuous activity, fever, caffeine, nicotine, alcohol and some medicines. Dehydration or low blood sugar can also make the heartbeat feel more noticeable. Anaemia, iron deficiency anaemia and an overactive thyroid can contribute by making the heart work harder. An irregular rhythm such as atrial fibrillation is another possible cause; palpitations alone cannot identify the cause.

A clinician may ask about your symptoms, check your pulse and blood pressure, and arrange an electrocardiogram. Blood tests or a longer heart-rhythm recording may be useful when episodes are intermittent or a medical trigger is suspected.

Stop strenuous activity and sit somewhere safe. Breathe slowly and regularly, and sip water if you may be dehydrated. Avoid taking extra doses of a medicine or using someone else’s treatment to slow your heartbeat.

Record when the sensation started, how long it lasted, whether the rhythm felt regular or uneven, what you were doing, and any associated symptoms. Note caffeine, nicotine, alcohol, illness and medicines around the episode. Arrange a routine appointment if episodes recur, last longer than usual, or interfere with daily activities.

Seek emergency help if palpitations are accompanied by chest pain or pressure, severe breathlessness, fainting, near-fainting, confusion, or marked dizziness. Seek prompt medical advice for a fast or irregular heartbeat that does not settle, especially if you have known heart disease or symptoms such as swelling and breathlessness that could occur with heart failure.

Do not drive yourself if you feel faint or seriously unwell. If the episode has stopped but warning symptoms occurred, explain exactly what happened when you contact a healthcare service.

Ask whether your description suggests an irregular rhythm, whether an electrocardiogram or blood tests are appropriate, and whether any prescribed or over-the-counter medicine could be contributing. Share your episode record, relevant medical history and family history of heart rhythm problems.