What should you know about random heart palpitations?

You may notice pounding in your chest, a flutter, a pause followed by a stronger beat, or a fast pulse. Palpitations can happen at rest or during activity. Emotional stress, poor sleep, strenuous exercise, caffeine, nicotine, alcohol and some medicines can trigger them. Fever, dehydration, low blood sugar, an overactive thyroid or anaemia can also affect the heartbeat. A breastbone or chest sensation is not enough to identify the cause.

A palpitation is a symptom rather than a diagnosis. Some people have an abnormal rhythm such as atrial fibrillation, while others have a normal rhythm that feels unusually strong. Heart failure can also be associated with awareness of the heartbeat, especially when breathlessness or ankle swelling is present. The symptom alone cannot distinguish these possibilities.

Sit down, breathe slowly and avoid driving if you feel faint. Record when the episode began, how long it lasted, what you were doing, and whether the beat felt regular or irregular. Note chest discomfort, breathlessness, dizziness or fainting, along with recent illness, missed meals, new medicines and stimulants. Hydrate if you can drink safely, and do not take someone else’s heart medicine or try forceful manoeuvres without medical advice.

Arrange a clinical review if episodes keep returning, last longer than usual, occur with exercise, or are becoming more intense. A clinician may check your pulse and blood pressure, review medicines and order an electrocardiogram or blood tests for causes such as thyroid problems, anaemia or low blood sugar.

Seek emergency help now if palpitations do not settle or occur with chest pain, severe breathlessness, fainting, marked dizziness, confusion, or new weakness on one side. Do not drive yourself. A very rapid or irregular heartbeat with these symptoms can require prompt treatment, even if the episode later stops.

Contact a healthcare professional promptly for a first episode, repeated episodes, a known heart condition, or palpitations during pregnancy. Bring your episode notes and a list of medicines, supplements and energy products.

Ask: Could my medicines, thyroid function, blood count, hydration or blood sugar be contributing? Do I need an electrocardiogram or a wearable rhythm monitor? Which symptoms should prompt emergency help? Should I change caffeine, nicotine, alcohol or exercise while this is being assessed?