What should you know about painful heart palpitations?

Palpitations may feel fast, forceful, irregular, fluttering, or like a missed beat. Stress, poor sleep, caffeine, nicotine, fever, dehydration, and some medicines can trigger them. Anaemia or Iron Deficiency Anaemia may make the heart beat harder to deliver oxygen. Hyperthyroidism, low blood sugar, or Atrial Fibrillation can also cause noticeable rhythm changes. Heart Failure may cause palpitations with breathlessness, swelling, or reduced exercise tolerance. Chest pain can come from the heart or another cause, but it should not be dismissed when it occurs with palpitations.

Stop exertion, sit or lie safely, and breathe slowly. Note the start time, duration, rhythm sensation, activity, food, caffeine, medicines, and associated symptoms. Drink fluids if dehydration is possible and you can safely do so. Do not drive yourself if you feel faint or unwell. Arrange a clinical review for new, recurrent, or worsening episodes; an examination and heart-rhythm recording may be considered.

Call emergency services for palpitations with ongoing chest pressure or pain, severe breathlessness, fainting, collapse, confusion, or sudden one-sided weakness. Urgent assessment is also needed when a very fast or irregular heartbeat persists, especially with dizziness. Seek prompt advice for episodes after starting a medicine or with known heart disease.

Could the rhythm be irregular or related to anaemia, thyroid changes, dehydration, or low blood sugar? Do I need an ECG or other monitoring? Which triggers should I avoid? What symptoms require emergency care?