Heart palpitations: causes, what they feel like and when to worry

The NHS says heart palpitations are common and not usually a sign of anything serious. The BHF similarly says that in most cases they are harmless and often feel more serious than they are.

Common triggers the NHS lists are strenuous exercise, lack of sleep, stress and anxiety, medicines (check the leaflet), and alcohol, caffeine, nicotine and recreational drugs. The BHF adds smoking or vaping, intense exercise, panic attacks and triggering foods such as spicy or rich food.

When you have palpitations, the NHS says your heartbeat feels uncomfortable or unusual, and you may feel it in your chest, neck or throat. It may feel like it is racing or beating very fast, irregular with skipped or extra beats, pounding or thumping, or fluttering.

The BHF says palpitations can happen at any time, even if you are resting or doing normal activities, and can last seconds or minutes but sometimes last longer.

A palpitation is when you suddenly become aware of your heartbeat. The BHF defines it as your heart pounding or beating more quickly than usual. It is a sensation rather than a diagnosis, so the aim is to work out whether it has an ordinary trigger or a condition behind it.

The NHS says sometimes heart palpitations can be a sign you are going through the menopause, and that some people get them during pregnancy. The BHF lists hormonal changes due to pregnancy or menopause as a cause.

Because palpitations in pregnancy can also relate to other conditions the NHS lists, such as iron deficiency anaemia or an overactive thyroid, mention them to your midwife or GP, who can arrange checks.

The BHF notes that some people have palpitations when lying down for the night. Neither the NHS nor the BHF gives a single cause for this, but the BHF says palpitations can happen at any time, even at rest. The triggers listed above, such as caffeine, alcohol, stress and lack of sleep, apply whatever the time of day.

The NHS and BHF advice is the same by night or day. See a GP if they keep coming back, last longer than a few minutes, or you have a heart condition.

The NHS says you may have an electrocardiogram (ECG) to help find out what the cause might be, in which small pads are stuck to your skin to check the electrical signals coming from your heart. You may be referred to a heart specialist (cardiologist) for tests and treatment.

The BHF says the ECG is painless and lasts a few minutes. If it shows something abnormal, or your symptoms continue to bother you, you may need further tests or heart monitoring over a longer period, for example a 24-hour ECG.

The NHS says treatment depends on the cause and they often do not need to be treated. Avoiding triggers such as stress, smoking, caffeine and alcohol can help if palpitations are not caused by a health condition.

If a heart problem is the cause, the NHS says you may need medicines or a procedure to help control your heartbeat. The BHF gives the example of beta blockers to control heart rate and rhythm in arrhythmia.

• Avoid or drink less caffeinated drinks.

• Drink less alcohol or none, keeping to no more than 14 units a week.

• Keep a symptom diary to recognise and avoid triggers.

• Manage your stress levels.

• Do not smoke or use tobacco products.

The NHS says to see a GP if you have had palpitations and feel well but they keep coming back or are happening more often, they last longer than a few minutes, you have a heart condition, or you have a family history of heart problems. The BHF similarly says to see your GP if they last a long time, do not improve or get worse, you have a history of heart problems or you are concerned.

Call 999 or go to A&E if you currently have palpitations that do not go away or you also have chest pain, shortness of breath or feeling faint or fainting. The BHF lists severe shortness of breath, chest pain or tightness, dizziness and light-headedness, and fainting or blackouts. If you have had these symptoms but they have stopped, the NHS says to ask your GP surgery for an urgent appointment, call 111 or get help from 111 online. Do not drive to A&E.

On the NHS a GP can arrange an ECG and refer you to a cardiologist if needed, with longer monitoring if your symptoms come and go. The BHF says you may need heart monitoring over a longer period if the first ECG is normal but symptoms continue.

Private cardiology clinics also offer ECGs, heart monitors and consultations, sometimes with shorter waits. A private ECG while you are not having symptoms may be normal, so ask what monitoring is planned and share any results with your GP.