Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Heart palpitations — the sensation of your heart racing, fluttering, pounding, or skipping a beat — are one of the most common reasons people seek cardiology advice. Most palpitations are harmless, but understanding when they need investigation is important.
Palpitations can be triggered by caffeine, alcohol, stress and anxiety, dehydration, hormonal changes, certain medications, and intense exercise. They can also be caused by underlying heart rhythm conditions such as atrial fibrillation, supraventricular tachycardia, or ectopic beats (extra or skipped heartbeats), which are extremely common and usually benign.
Occasional, brief palpitations without other symptoms — particularly linked to caffeine, stress or exercise — are usually not a cause for concern. Ectopic beats (a single skipped or extra beat) are very common and rarely indicate a serious problem. For more on telling palpitations from anxiety, see /blog/palpitations-vs-anxiety.
Seek assessment if palpitations are frequent, prolonged, or accompanied by chest pain, breathlessness, dizziness, fainting, or a family history of heart conditions or sudden cardiac death. A resting ECG and, where needed, a Holter monitor (24-hour to 7-day heart rhythm recording) can identify the underlying cause.
At The Cardiology Doctors, assessment typically includes a 12-lead ECG, clinical history review, and where appropriate, ambulatory monitoring with a Holter monitor to capture rhythm over a longer period, or an echocardiogram to assess heart structure. Same-day results are available where possible.
Most palpitations are harmless and linked to caffeine, stress, or exercise. However, palpitations accompanied by chest pain, breathlessness, or fainting should be assessed promptly.
Palpitations are the sensation of an abnormal heartbeat, which may or may not reflect a true rhythm abnormality. An ECG or Holter monitor is needed to determine if there is an underlying arrhythmia.
If palpitations are frequent, lasting more than a few seconds, or accompanied by other symptoms, you should seek assessment rather than waiting.
A resting ECG captures the heart's rhythm at the time of the test. If palpitations are intermittent, a Holter monitor worn for 24 hours to 7 days is often more effective at capturing the episode.