Palpitations: Causes, Urgent Signs and Assessment

Palpitations are a noticeable heartbeat that may feel fast, forceful, irregular, fluttering or as if beats are being skipped.

The sensation may be felt in the chest, throat or neck. It can start abruptly or build gradually, last briefly or recur, and may appear at rest, after exertion, during stress or after particular foods, drinks or medicines. Recording what was happening at the time can help the assessment.

Seek urgent medical help if palpitations occur with chest pain, fainting, near-fainting, severe breathlessness, new weakness, confusion, or a sustained very unwell feeling. Urgent assessment is also appropriate if a rapid or irregular heartbeat does not settle and you feel unwell.

Book a medical review if episodes are new, becoming more frequent, interrupt sleep or activity, occur with dizziness, or you have known heart disease, thyroid disease or a family history of sudden unexplained death.

Palpitations can arise from changes in heart rhythm, hydration, blood sugar, hormones, blood cell levels, emotional stress, stimulants or medicines. The conditions below are in alphabetical order and do not indicate how likely any one cause is.

A clinician will ask about the rhythm sensation, timing, triggers, medicines and supplements, caffeine or nicotine use, sleep, illness and family history. They may check your pulse, blood pressure, heart and lungs, and look for signs of dehydration, anaemia or thyroid disease.

An electrocardiogram records the heart's electrical activity at that moment. If episodes come and go, you may be offered monitoring over a longer period. Blood tests can check for contributors such as anaemia, thyroid changes, electrolyte disturbance or low blood glucose when appropriate.

Treatment depends on what is driving the episodes. It may involve restoring fluids, adjusting a medicine with clinical guidance, treating low blood glucose, correcting anaemia, managing thyroid disease, or using a heart-rhythm plan. Anxiety or panic symptoms can be treated with psychological support, practical coping strategies and, when appropriate, medication.

Do not stop prescribed heart, thyroid or mental health medicines without advice. Take a list of everything you use, including inhalers, decongestants, energy products and herbal preparations, because these may influence heart rhythm.

Regular fluids, consistent meals, sleep, and avoiding known triggers can reduce episodes for some people. Consider moderating caffeine, nicotine, alcohol and energy products if you notice a clear connection. Avoid using someone else's prescribed medicine to control a fast heartbeat.

If palpitations follow a new medicine or supplement, contact the prescriber or pharmacist for advice rather than making abrupt changes yourself.

Mention chest discomfort, breathlessness, faintness, sweating, tremor, fever, weight change, ankle swelling, fatigue, heavy menstrual bleeding, vomiting, diarrhoea, thirst or panic feelings. The pattern of accompanying symptoms helps focus testing and treatment.

A documented rhythm during symptoms can distinguish different patterns and guide safer care. Follow-up is particularly useful when episodes change, occur during exercise, or affect work, driving, sleep or daily confidence.