Heart pain and palpitations: what to know

Palpitations are an awareness of a racing, fluttering, pounding, or uneven heartbeat. Chest pain may feel like pressure, tightness, burning, stabbing, or soreness, and its cause can involve the heart, lungs, muscles, nerves, or digestive system. Anaemia, dehydration, hypoglycaemia, hyperthyroidism, anxiety, and atrial fibrillation can be associated with palpitations. Heart failure may be associated with breathlessness, swelling, and reduced stamina. The combination does not identify one diagnosis, and symptom direction matters: conditions can present with palpitations, while palpitations do not prove a particular condition.

Record where the pain is, what it feels like, what brings it on, how long it lasts, and whether the heartbeat feels regular. Note breathlessness, sweating, nausea, dizziness, or pain that travels elsewhere.

Stop exertion and sit upright in a safe place. Avoid driving yourself if symptoms are significant. If the episode settles but returns, arrange a clinical review; an ECG, blood tests, or longer heart monitoring may be considered. Keep taking prescribed medicines as directed unless a clinician tells you otherwise, and do not use another person’s medicine to treat chest symptoms.

Call emergency services immediately for chest pressure or pain that persists, severe breathlessness, fainting, sudden weakness, confusion, cold sweating, or pain spreading to the arm, back, neck, or jaw. Urgent assessment is also needed for a new irregular heartbeat with dizziness or marked weakness. Even if symptoms improve, seek prompt medical advice when this combination is new or unexplained.

Could the pain and heartbeat sensation have the same cause? Do I need an ECG, blood tests, or longer monitoring? Which symptoms should prompt emergency help? Could dehydration, anaemia, thyroid problems, or medicines be contributing?