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Palpitations, felt as a sudden thump, flutter, or skipped beat in the chest, can feel alarming. Most of the time, these sensations are harmless and short-lived. Since the heart is involved, it makes it essential to pay attention. Understanding what triggers heart palpitations, when they are likely benign, and when they point to a serious problem helps you act quickly and calmly. The goal is simple: recognise red flags, get the right tests when needed, and use the episode as an opportunity to protect your long-term heart health.
Synopsis
- What Are Heart Palpitations?
- Common Causes of Palpitations
- When to Be Concerned: Red Flags
- Palpitation Symptoms to Look Out For
- How Palpitations Relate to Heart Failure?
- What Your Doctor Will Ask and Which Tests to Expect
- How Heart Palpitations Are Treated?
- Practical Self-Care You Can Do Right Now
- Conclusion
What Are Heart Palpitations?
A heart palpitation is any sensation that makes you suddenly aware of your heartbeat. People describe palpitations as pounding, fluttering, racing, skipping, or “flip-flops.” They can last a few seconds or persist for minutes. Sometimes they come on with exercise, caffeine, or stress; other times they appear out of nowhere.
Because palpitations are a symptom, not a diagnosis, the key question is what lies behind them. Triggers range from harmless to serious, and your medical history, the way the episode felt, and whether other symptoms were present will guide what happens next.
Common Causes of Palpitations
Several everyday things can cause heart palpitations. Common triggers include stimulant drinks and drugs, anxiety or panic, fever, dehydration, low blood sugar, anaemia, thyroid imbalances, and some medicines (including some cold remedies). Exercise and excitement are normal causes. Sometimes, structural heart disease, previous heart attacks, valvular problems, or abnormal electrical pathways in the heart can also cause palpitations, needing medical evaluation.
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Triggers |
Causes |
|
Lifestyle |
Caffeine, alcohol, nicotine, energy drinks |
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Emotional |
Stress, anxiety, panic attacks |
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Physiological |
Fever, dehydration, low potassium or low blood sugar, anaemia, thyroid problems |
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Medication or substance-related |
Certain asthma inhalers, decongestants, stimulants, and recreational drugs |
|
Cardiac causes |
Arrhythmias (like atrial fibrillation or ventricular ectopics), structural heart disease, prior heart attack |
When to Be Concerned: Red Flags
Most palpitations are harmless, but there are important warning signs you must not ignore. Seek urgent care if palpitations are accompanied by:
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Chest pain or pressure
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Fainting, near-fainting, or sudden dizziness
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Severe breathlessness or difficulty breathing
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Palpitations that start suddenly and are very fast (for example, a sustained rapid heart rate) or are getting steadily worse
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A history of heart disease, prior heart attack, or known valve problems
If any of the above occur, get immediate medical attention. Even without these symptoms, persistent or progressively frequent palpitations deserve evaluation. The British Heart Foundation and local hospital guidelines emphasise that while palpitations often feel worse than they are, new or changing palpitations need a clinician’s review.
Palpitation Symptoms to Look Out For
|
Symptom or Finding |
Why It Matters |
What You Should Do |
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Chest pain with palpitations |
Could signal myocardial ischemia or a dangerous arrhythmia |
Call emergency services or go to A&E immediately |
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Fainting (syncope) with palpitations |
Suggests a transient loss of brain perfusion — serious |
Emergency assessment; urgent ECG and monitoring |
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Sudden severe breathlessness |
May indicate heart failure or a pulmonary problem |
Urgent medical review; consider A&E |
|
Recurrent palpitations that are new or worsening |
May reflect a treatable arrhythmia or worsening heart disease |
See your GP/urgent clinic; likely ECG/ambulatory monitor |
|
Palpitations with leg swelling or rapid weight gain |
Possible fluid retention from congestive heart failure |
See a doctor promptly; may need heart failure workup |
How Palpitations Relate to Heart Failure?
Palpitations are not a classic early symptom of heart failure, but they are important to consider because abnormal heart rhythms can lead to or worsen heart pumping function. If palpitations occur with shortness of breath, swelling of the legs, unexplained tiredness, or sudden weight gain from fluid retention, you must assume the heart might be struggling.
Congestive heart failure often presents with breathlessness, reduced exercise tolerance, and fluid buildup; arrhythmias such as atrial fibrillation can both trigger and result from heart failure. That two-way relationship means palpitations plus any signs of fluid overload or heart failure symptoms need timely evaluation. Public-health and clinical guidelines highlight early detection and management of both rhythm problems and pump failure to reduce complications.
What Your Doctor Will Ask and Which Tests to Expect
When you see a cardiologist about heart palpitations, expect a focused history and a thorough exam. The way palpitations start, how long they last, what triggers them, and any accompanying symptoms are all critical.
Typical initial tests include a resting electrocardiogram (ECG) to capture rhythm, blood tests (thyroid function, electrolytes, full blood count), and sometimes a chest X-ray. If the ECG is normal but symptoms persist or are intermittent, ambulatory ECG monitoring (Holter or event monitor) is common. An echocardiogram is sometimes recommended for structural or pumping problems, and stress testing or additional cardiac imaging may be needed if ischemia is suspected.
How Heart Palpitations Are Treated?
Treatment depends on the cause. If a trigger is obvious, such as caffeine, dehydration, or anxiety, modifying the trigger often stops the palpitations. For arrhythmias, options range from medications that control rate or rhythm to procedures such as electrical cardioversion or catheter ablation for certain rhythm disorders.
If palpitations are part of heart failure, treatment focuses on stabilising the heart’s pumping function alongside rhythm control. Guideline-directed therapy for heart failure improves symptoms, reduces admissions, and helps control associated arrhythmias. Your doctor will tailor treatment to the rhythm problem, your heart function, and overall health.
Practical Self-Care You Can Do Right Now
You can’t prevent every palpitation, but you can reduce many triggers and lower the risk of underlying heart disease:
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Sit down and breathe slowly: Calming your nervous system often reduces palpitations.
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Avoid stimulants: Skip caffeine, nicotine, and alcohol until you know more.
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Keep blood pressure, blood sugar, and cholesterol under control.
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Note timing and triggers: Keep a short log (what you did before, how long it lasted, other symptoms).
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Manage stress with sleep, structured relaxation, or therapy.
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If the episode is short and you feel well afterwards, book an appointment to check baseline tests.
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Stay hydrated and correct any electrolyte losses (especially in hot weather or after vomiting/diarrhoea).
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If you have known heart disease, keep regular follow-ups and adhere to medications.
If palpitations are new, very rapid, or occur with breathlessness, chest pain, or fainting, seek emergency care immediately.
Conclusion
Palpitations are common and often harmless, but your instincts matter. If an episode feels different, is new, comes with breathlessness or chest pain, or you have a history of heart disease, treat it seriously. Use a medical evaluation to rule out dangerous rhythms or underlying heart failure and to get a clear plan. With timely assessment and the right follow-up at Manipal Hospital Jayanagar, most people with palpitations can be reassured or treated effectively so they can get back to normal lives.
If you experience frequent palpitations, persistent chest discomfort, or breathlessness, consult a specialist for proper evaluation. Get expert cardiac care at Manipal Hospitals Jayanagar with guidance from experienced cardiologists for diagnosis and treatment options.
FAQ's
Occasional skipped beats (premature contractions) are common and usually benign, especially in young people without heart disease. If they are new, frequent, or cause dizziness or chest pain, see your doctor for an ECG and further tests.
Yes. Anxiety and panic can produce intense palpitations that feel frightening, but are often not caused by structural heart disease. Still, new episodes should be checked to rule out other causes.
Palpitations themselves are not a classic first sign of congestive heart failure, but arrhythmias can occur with heart failure and may worsen symptoms. If palpitations come with breathlessness, swelling, or sudden weight gain, see a clinician promptly.
An ECG, ambulatory monitoring (Holter), blood tests, and an echocardiogram are the mainstays. The combination of tests chosen depends on your story and exam.
Go to emergency care if palpitations occur with chest pain, fainting, severe breathlessness, or if the heartbeat is extremely rapid and prolonged. These are potential signs of a life-threatening rhythm or cardiac event.
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