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What Are Palpitations?

Palpitations (pal-pi-TA-shuns) are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Overview

Many things can trigger palpitations, including:

  • Strong emotions
  • Vigorous physical activity
  • Medicines such as diet pills and decongestants
  • Caffeine, alcohol, nicotine, and illegal drugs
  • Certain medical conditions, such as thyroid disease or anemia
    (uh-NEE-me-uh)

These factors can make the heart beat faster or stronger than usual, or they can cause premature (extra) heartbeats. In these situations, the heart is still working normally. Thus, these palpitations usually are harmless.

Some palpitations are symptoms of arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.

Some arrhythmias are signs of heart conditions, such as heart attack, heart failure, heart valve disease, or heart muscle disease. However, less than half of the people who have palpitations have arrhythmias.

You can take steps to reduce or prevent palpitations. Try to avoid things that trigger them (such as stress and stimulants) and treat related medical conditions.

Outlook

Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can decide whether you need treatment or ongoing care.




What Causes Palpitations?

Many things can cause palpitations. You may have these feelings even when your heart is beating normally or somewhat faster than normal.

Most palpitations are harmless and often go away on their own. However, some palpitations are signs of a heart problem. Sometimes the cause of palpitations can't be found.

If you start having palpitations, see your doctor to have them checked.

Causes Not Related to Heart Problems

Strong Emotions

You may feel your heart pounding or racing during anxiety, fear, or stress. You also may have these feelings if you're having a panic attack.

Vigorous Physical Activity

Intense activity can make your heart feel like it’s beating too hard or too fast, even though it's working normally. Intense activity also can cause occasional premature (extra) heartbeats.

Medical Conditions

Some medical conditions can cause palpitations. These conditions can make the heart beat faster or stronger than usual. They also can cause premature (extra) heartbeats.

Examples of these medical conditions include:

  • An overactive thyroid
  • A low blood sugar level
  • Anemia
  • Some types of low blood pressure
  • Fever
  • Dehydration (not enough fluid in the body)

Hormonal Changes

The hormonal changes that happen during pregnancy, menstruation, and the perimenopausal period may cause palpitations. The palpitations will likely improve or go away as these conditions go away or change.

Some palpitations that occur during pregnancy may be due to anemia.

Medicines and Stimulants

Many medicines can trigger palpitations because they can make the heart beat faster or stronger than usual. Medicines also can cause premature (extra) heartbeats.

Examples of these medicines include:

  • Inhaled asthma medicines.
  • Medicines to treat an underactive thyroid. Taking too much of these medicines can cause an overactive thyroid and lead to palpitations.
  • Medicines to prevent arrhythmias. Medicines used to treat irregular heart rhythms can sometimes cause other irregular heart rhythms.

Over-the-counter medicines that act as stimulants also may cause palpitations. These include decongestants (found in cough and cold medicines) and some herbal and nutritional supplements.

Caffeine, nicotine (found in tobacco), alcohol, and illegal drugs (such as cocaine and amphetamines) also can cause palpitations.

Causes Related to Heart Problems

Some palpitations are symptoms of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. However, less than half of the people who have palpitations have arrhythmias.

During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. An arrhythmia happens if some part of the heart's electrical system doesn't work as it should.

Palpitations are more likely to be related to an arrhythmia if you:




Who Is at Risk for Palpitations?

Some people may be more likely than others to have palpitations. People at increased risk include those who:

Women who are pregnant, menstruating, or perimenopausal also may be at higher risk for palpitations because of hormonal changes. Some palpitations that occur during pregnancy may be due to anemia.

For more information about these risk factors, go to "What Causes Palpitations?"




What Are the Signs and Symptoms of Palpitations?

Symptoms of palpitations include feelings that your heart is:

  • Skipping a beat
  • Fluttering
  • Beating too hard or too fast

You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Palpitations often are harmless, and your heart is working normally. However, these feelings can be a sign of a more serious problem if you also:

  • Feel dizzy or confused
  • Are light-headed, think you may faint, or do faint
  • Have trouble breathing
  • Have pain, pressure, or tightness in your chest, jaw, or arms
  • Feel short of breath
  • Have unusual sweating

Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if your palpitations:

  • Start to occur more often or are more noticeable or bothersome
  • Occur with other symptoms, such as those listed above

Your doctor will want to check whether your palpitations are the symptom of a heart problem, such as an arrhythmia (irregular heartbeat).




How Are Palpitations Diagnosed?

First, your doctor will want to find out whether your palpitations are harmless or related to a heart problem. He or she will ask about your symptoms and medical history, do a physical exam, and recommend several basic tests.

This information may point to a heart problem as the cause of your palpitations. If so, your doctor may recommend more tests. These tests will help show what the problem is, so your doctor can decide how to treat it.

The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.

Specialists Involved

Several types of doctors may work with you to diagnose and treat your palpitations. These include a:

  • Primary care doctor
  • Cardiologist (a doctor who specializes in diagnosing and treating heart diseases and conditions)
  • Electrophysiologist (a cardiologist who specializes in the heart's electrical system)

Medical History

Your doctor will ask questions about your palpitations, such as:

  • When did they begin?
  • How long do they last?
  • How often do they occur?
  • Do they start and stop suddenly?
  • Does your heartbeat feel steady or irregular during the palpitations?
  • Do other symptoms occur with the palpitations?
  • Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?

Your doctor also may ask about your use of caffeine, alcohol, supplements, and illegal drugs.

Physical Exam

Your doctor will take your pulse to find out how fast your heart is beating and whether its rhythm is normal. He or she also will use a stethoscope to listen to your heartbeat.

Your doctor may look for signs of conditions that can cause palpitations, such as an overactive thyroid.

Diagnostic Tests

Often, the first test that's done is an EKG (electrocardiogram). This simple test records your heart's electrical activity.

An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.

Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart's structure, function, and electrical system.

Holter or Event Monitor

A standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't happen during the test. To diagnose problems that come and go, your doctor may have you wear a Holter or event monitor.

A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

During the 24- or 48-hour period, you do your usual daily activities. You use a notebook to record any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.

For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.

You can wear an event monitor for weeks or until symptoms occur.

Holter or Event Monitor

Figure A shows how a Holter or event monitor attaches to a patient. In this example, the monitor is clipped to the patient's belt and electrodes are attached to his chest. Figure B shows an electrocardiogram strip, which maps the data from the Holter or event monitor.  

Figure A shows how a Holter or event monitor attaches to a patient. In this example, the monitor is clipped to the patient's belt and electrodes are attached to his chest. Figure B shows an electrocardiogram strip, which maps the data from the Holter or event monitor.

Echocardiography

Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.




How Are Palpitations Treated?

Treatment for palpitations depends on their cause. Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed.

Avoiding Triggers

Your palpitations may be harmless but bothersome. If so, your doctor may suggest avoiding things that trigger them. For examples, your doctor may advise you to:

  • Reduce anxiety and stress. Anxiety and stress (including panic attacks) are a common cause of harmless palpitations. Relaxation exercises, yoga or tai chi, biofeedback or guided imagery, or aromatherapy may help you relax.
  • Avoid or limit stimulants, such as caffeine, nicotine, or alcohol.
  • Avoid illegal drugs, such as cocaine and amphetamines.
  • Avoid medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements.

Treating Medical Conditions That May Cause Palpitations

Work with your doctor to control medical conditions that can cause palpitations, such as an overactive thyroid. If you're taking medicine that's causing palpitations, your doctor will try to find a different medicine for you.

If your palpitations are caused by an arrhythmia (irregular heartbeat), your doctor may recommend medicines or procedures to treat the problem. For more information, go to the Health Topics Arrhythmia article.




How Can Palpitations Be Prevented?

You can take steps to prevent palpitations. Try to avoid things that trigger them. For example:

  • Reduce anxiety and stress. Anxiety and stress (including panic attacks) are a common cause of harmless palpitations. Relaxation exercises, yoga or tai chi, biofeedback or guided imagery, or aromatherapy may help you relax.
  • Avoid or limit stimulants, such as caffeine, nicotine, or alcohol.
  • Avoid illegal drugs, such as cocaine and amphetamines.
  • Avoid medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements.

Also, work with your doctor to treat medical conditions that can cause palpitations.




Living With Palpitations

Most palpitations are harmless and often go away on their own. Treatment usually isn’t needed in these cases. Your doctor may advise you to avoid triggers for palpitations. (For more information, go to "How Are Palpitations Treated?")

Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if they get worse, start to occur more often, become more noticeable or bothersome, or occur with other symptoms.

Your doctor will tell you about other signs and symptoms to be aware of and when to seek emergency care.

A medical condition or heart problem might be the cause of your palpitations. If so, your doctor will give you advice and treatment for your condition.




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to palpitations, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.




Links to Other Information About Palpitations

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

 
July 01, 2011 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.

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