Palpitations are sensations of feeling the heart beat fast, hard, irregularly, or as if it is skipping beats. Many palpitations are benign, but some may be caused by arrhythmias, thyroid disease, electrolyte abnormalities, structural heart disease, stimulant use, sleep issues, stress, or medication effects.
Because palpitations may be intermittent, rhythm monitoring is often helpful to connect symptoms with the heart rhythm at the time they occur.
Symptoms patients may notice
- Fluttering, pounding, racing, or skipped beats
- Episodes that occur at rest, during exertion, after caffeine or alcohol, or during stress
- Lightheadedness, shortness of breath, chest discomfort, or fatigue
- Palpitations with fainting or near-fainting
How we evaluate this condition
- EKG and symptom history
- Holter monitor, patch monitor, or event monitor based on symptom frequency
- Echocardiogram when structural heart disease is suspected
- Blood tests and medication/stimulant review when appropriate
Treatment and care options
- Reassurance and monitoring when benign extra beats are confirmed
- Lifestyle changes such as reducing caffeine, alcohol, dehydration, and stimulant exposure
- Medication therapy for selected rhythm disorders
- Electrophysiology referral or ablation evaluation when symptoms are significant or rhythm findings require it
When to seek urgent care
Call 911 if palpitations occur with fainting, chest pain, severe shortness of breath, stroke symptoms, or severe weakness.