Heart Palpitations: Causes, Symptoms, and When to Seek Care

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.

What are heart palpitations?

Heart palpitations are the subjective feeling of an abnormal heartbeat. People describe them as rapid beating, fluttering, or a sensation of skipped beats. Palpitations may last only a few seconds or persist for minutes. They can occur at rest or during activity and may be felt in the neck or chest. Causes range from temporary triggers like caffeine or dehydration to rhythm disturbances (arrhythmias) that warrant clinical evaluation.

Why do palpitations cause chest sensations?

Palpitations often produce noticeable chest sensations because the heart’s forceful or irregular contractions change the pressure and movement within the chest cavity. This can feel like pounding, a thumping under the sternum, or a fluttering near the left chest wall. Non-cardiac causes such as acid reflux, muscle strain, or anxiety can also produce chest sensations that mimic palpitations. Distinguishing cardiac from non-cardiac chest sensations typically requires a clinical assessment including history, physical exam, and sometimes diagnostic tests.

How do anxiety and stress trigger palpitations?

Anxiety and stress activate the sympathetic nervous system, releasing adrenaline and other stress hormones that increase heart rate and contractility. This physiological response can cause palpitations, shortness of breath, and a sense of chest tightness. Panic attacks often produce intense palpitations alongside dizziness and sweating. Chronic stress and persistent anxiety may increase the frequency of palpitations. Addressing stressors, practicing relaxation techniques, and seeking mental health support can reduce episodes, but evaluation is needed to rule out heart-related causes.

When are palpitations a sign of a heart problem?

Palpitations are more concerning when they are accompanied by fainting, near-fainting, chest pain, shortness of breath, lightheadedness, or if they occur in people with known heart disease. Frequent, sustained, or progressively worsening palpitations may indicate arrhythmias such as atrial fibrillation, supraventricular tachycardia, or ventricular arrhythmias. Risk increases with age, prior heart attack, heart failure, significant high blood pressure, or structural heart abnormalities. A healthcare provider can assess risk and recommend testing to determine whether palpitations reflect a cardiac problem.

How are palpitations evaluated and managed?

Evaluation often starts with a detailed history and physical exam. Providers ask about onset, duration, triggers, associated symptoms, medical history, and medications. Initial testing commonly includes an ECG and possibly blood tests (electrolytes, thyroid function). If palpitations are infrequent, ambulatory monitoring (Holter monitor or event recorder) may be used to capture heart rhythm during symptoms. Management depends on the cause: benign triggers may be managed with lifestyle changes (reducing caffeine, managing stress), while arrhythmias might need medications, catheter ablation, or other interventions. Referral to cardiology is appropriate when cardiac causes are suspected.

What self-care and lifestyle steps can help reduce palpitations?

Many palpitations respond to simple measures. Limiting caffeine and stimulants, staying hydrated, ensuring adequate sleep, and moderating alcohol intake can reduce episodes. Stress-reduction techniques—such as diaphragmatic breathing, progressive muscle relaxation, mindfulness, or cognitive-behavioral strategies—can lessen palpitations related to anxiety. Regular physical activity tailored to your fitness level supports cardiovascular health but consult a healthcare provider before starting exercise if you have concerning symptoms. Keep a symptom diary noting timing, duration, activities, and possible triggers to assist clinical evaluation.

Conclusion

Heart palpitations are a common symptom with many possible causes, from benign triggers like stress and caffeine to medical conditions that require treatment. Paying attention to accompanying symptoms and patterns helps differentiate harmless episodes from those requiring prompt medical assessment. If palpitations are frequent, prolonged, or tied to fainting, chest pain, or breathlessness, seek evaluation by a healthcare professional to determine appropriate testing and management.