Heart palpitations: causes, red flags and when to seek help

The NHS describes palpitations as your heartbeat becoming more noticeable, felt in the chest, neck or throat, and gives four common patterns: racing or beating very fast, irregular with skipped or extra beats (ectopic beats), pounding or thumping, and fluttering. They can last seconds, minutes or longer.

A useful skill is to describe the rhythm precisely, perhaps by tapping it out. A single hard thump after a pause is typical of an ectopic beat. A sudden-onset, sudden-offset fast regular rhythm suggests a supraventricular tachycardia. A fast, chaotically irregular rhythm suggests atrial fibrillation. A gradually speeding then slowing sensation is more typical of anxiety or exertion.

The NHS says common causes include strenuous exercise, lack of sleep, stress and anxiety, medicines (check the leaflet), and alcohol, caffeine, nicotine and recreational drugs. It adds that palpitations can sometimes be a sign you are going through the menopause, that some people get them during pregnancy, and that they can be caused by a condition such as iron deficiency anaemia, an overactive thyroid, a heart rhythm problem (arrhythmia) or other heart problems such as heart valve disease.

The NHS describes atrial fibrillation as a type of heart rhythm problem where your heartbeat is not steady, with an irregular pulse, sudden pounding, racing, fluttering or skipping, a heartbeat faster than 100 beats per minute, tiredness, finding it harder to exercise, chest pain or tightness, and feeling short of breath, lightheaded, dizzy or faint. Sometimes there are no symptoms and it is found on a routine check. It says AF can start and stop on its own, stop after treatment, or be present permanently, and is treated with medicines to control rate and rhythm, anticoagulants to lower the risk of blood clots or stroke, and procedures such as ablation or cardioversion.

The NHS says an overactive thyroid can cause nervousness, anxiety, irritability, difficulty sleeping, persistent tiredness, sensitivity to heat, an irregular or unusually fast heart rate, twitching or trembling and weight loss, that it is about 10 times more common in women than men and typically happens between 20 and 40 years of age, and that a blood test checks how well the thyroid is working.

The NHS says to call 999 or go to A&E if you currently have heart palpitations that do not go away or you also have chest pain, shortness of breath, or feeling faint or fainting. Do not drive; ask someone to drive you or call 999. If you have had these symptoms but they have stopped, ask your GP surgery for an urgent appointment, call 111 or get help from 111 online.

The NHS atrial fibrillation page adds that you should call 999 if you have a fast or irregular heartbeat with sweating, feeling or being sick, falling over, a severe headache, weakness or numbness on one side of your face or body, blurred vision or loss of sight, or confusion or difficulty speaking. Those last features suggest a stroke.

Palpitations during exercise, fainting without warning, or a family history of sudden unexplained death in a young relative deserve prompt specialist assessment, even if the episode has passed.

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. Expect questions about what the heartbeat feels like, how it starts and stops, how long it lasts, what you were doing, caffeine, alcohol and drug use, medicines, and symptoms such as chest pain, breathlessness or dizziness.

The doctor will check pulse rhythm and rate, blood pressure, listen to the heart for murmurs, look for signs of thyroid disease and anaemia, and arrange a 12-lead ECG, which the NHS describes as small pads stuck to the skin to check the electrical signals from the heart.

A resting ECG captures the rhythm only if it is happening, so intermittent palpitations are often recorded with a wearable monitor for 24 hours, several days or weeks, or a small device you press when symptoms occur. Blood tests commonly cover a full blood count, thyroid function, electrolytes and kidney function. An echocardiogram looks at heart structure and function. The NHS says treatment depends on the cause, they often do not need to be treated, and avoiding triggers such as stress, smoking, caffeine and alcohol helps when palpitations are not caused by a health condition. A referral to a cardiologist is made for tests and treatment if needed.

Keep a diary of when episodes occur, what you had been doing and what you had consumed. Cut back on caffeine, energy drinks, alcohol and nicotine, protect sleep and find ways to manage stress. Check the leaflets of medicines and ask a pharmacist about decongestants and other products that speed the heart. Do not stop prescribed medicines without advice.