Heart palpitations explained: causes and considerations

Palpitations are a common experience for many people, and while they can feel alarming, they are often harmless. The sensation of your heart beating rapidly, irregularly, or forcefully can raise concerns, especially if it happens frequently.

Leading consultant interventional cardiologist Dr Ashan Gunarathne explores what palpitations are, their possible causes, when you should be concerned, and how they can be diagnosed and treated. Understanding these factors can help you manage palpitations effectively and know when to seek medical advice.

What are palpitations?

Palpitations are the sensation that your heart is racing, pounding, or skipping a beat. While they can be unsettling, they are usually harmless in most cases. Many people experience palpitations from time to time, and they often come and go quickly. The sensation can feel like your heart is fluttering or beating harder than usual, and some individuals may also feel these sensations in their throat or chest. It’s important to know that palpitations do not always indicate a serious condition, but if they occur frequently or are accompanied by other symptoms, it’s best to seek medical advice.

What are the principal causes of palpitations?

There are many possible causes of palpitations. Often, they are related to lifestyle factors such as stress, anxiety, or caffeine consumption. When you are stressed or anxious, your body releases adrenaline, a hormone that can increase your heart rate. This is a normal response, but it can sometimes cause palpitations.

Other common triggers include exercise, dehydration, and stimulant medications (such as those for colds or asthma). Caffeine, nicotine, and alcohol can also lead to palpitations in some people. Even large meals, especially those high in sugar or carbohydrates, may cause a temporary increase in heart rate.

In some cases, palpitations may be related to underlying health conditions, such as thyroid issues (an overactive thyroid can make your heart race), anaemia (low red blood cell count), or heart arrhythmias (abnormal heart rhythms). Arrhythmias can vary in severity, from benign irregular beats to more serious conditions requiring medical intervention.

When are palpitations a cause for concern?

While occasional palpitations are often harmless, certain situations may require further investigation. You should contact your doctor if palpitations are frequent, long-lasting, or associated with other symptoms such as dizziness, shortness of breath, chest pain, or fainting. These could be signs of a more serious heart condition, such as atrial fibrillation (an irregular, often rapid heart rate), or other heart-related issues that need medical attention.

If you have a known heart condition, it’s important to be more vigilant with any new or unusual palpitations. Additionally, anyone with risk factors for heart disease, such as high blood pressure, high cholesterol, or diabetes, should speak to a healthcare professional if palpitations become a concern.

How are palpitations diagnosed?

To investigate palpitations, your doctor will first ask about your symptoms and medical history. They may also perform a physical examination. Diagnostic tests could include an electrocardiogram (ECG), which measures the electrical activity of the heart, or a Holter monitor, a portable device that tracks your heart's rhythm over 24 hours or longer. Blood tests may also be used to rule out conditions such as thyroid problems or anaemia.

In some cases, further tests like an echocardiogram (an ultrasound scan of the heart) or a stress test may be necessary, especially if there’s concern about a heart condition.

Can palpitations be treated?

Treatment depends on the underlying cause. If lifestyle factors like stress, caffeine, or dehydration are to blame, making simple changes may be all that’s needed. Reducing stress through relaxation techniques, limiting stimulants like caffeine, and staying well-hydrated can often help reduce or eliminate palpitations.

For those with an underlying medical condition, treating the cause—whether it’s managing thyroid issues, correcting anaemia, or addressing an arrhythmia—can often resolve the symptoms. In some cases, medications may be prescribed to help control your heart rate or rhythm, or a procedure may be required if there’s a more serious arrhythmia present.

If you experience palpitations, it’s important to stay calm and consult with your cardiologist to determine the best course of action.

If you are concerned about palpitations and would like to book a consultation with Dr Gunarathne, do not hesitate to do so by visiting his Top Doctors profile today.