Understanding Heart Palpitations: Causes and When to Seek Care
Heart palpitations are the sensation that your heart is pounding, fluttering, or beating irregularly. Many people notice palpitations during moments of exertion, after caffeine, or while feeling anxious. Although they can be alarming, palpitations have a wide range of causes — some harmless and others that warrant medical assessment. This article explains common triggers, related chest sensations, how anxiety and stress can play a role, and guidance on when to seek care so you can understand what might be happening.
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 palpitations?
Palpitations describe the subjective feeling of abnormal heartbeats — skipped beats, rapid beats, fluttering, or a pounding sensation. They can last a few seconds to several minutes and occur at rest or during activity. People often notice palpitations when becoming still and tuning into bodily sensations, or during changes in posture. While palpitations themselves are a symptom rather than a diagnosis, tracking their pattern, triggers, duration, and associated symptoms helps clinicians determine whether they stem from benign causes like caffeine or from arrhythmias that require further testing.
Heart-related causes
Several heart-related conditions can cause palpitations. Arrhythmias such as atrial fibrillation, supraventricular tachycardia, and premature ventricular contractions alter the heart’s electrical rhythm and produce noticeable palpitations. Structural heart disease — including valve problems, cardiomyopathy, or ischemic heart disease — can also contribute, especially in older adults or those with prior cardiac history. That said, many palpitations occur in people with normal hearts. Your age, medical history, medications, and risk factors like high blood pressure or prior heart events are important when evaluating whether palpitations point to a cardiac problem.
Chest sensations and other symptoms
Palpitations may be accompanied by symptoms in the chest such as pressure, tightness, pain, or an awareness of your heartbeat. Distinguishing between chest discomfort caused by musculoskeletal issues, reflux, anxiety, and cardiac causes is critical. Concerning signs that suggest a higher-risk cardiac event include lingering chest pain, shortness of breath, fainting or near-fainting, dizziness, or sweating. If palpitations occur alongside these symptoms, seek prompt medical evaluation. For isolated palpitations without other symptoms, a primary care clinician can often start the assessment and decide if cardiac testing is needed.
How anxiety and stress trigger palpitations
Anxiety and stress are common non-cardiac triggers of palpitations. The body’s fight-or-flight response releases adrenaline and other stress hormones that increase heart rate and can produce a sensation of fluttering or pounding. Panic attacks are a prominent example where intense anxiety causes rapid heartbeat, chest tightness, and breathlessness. Chronic stress and poor sleep can also lower the threshold for palpitations. Managing contributing factors — limiting caffeine, alcohol, and stimulants; improving sleep; practicing relaxation techniques such as deep breathing or mindfulness; and treating anxiety when present — may reduce palpitations for many people.
When to seek care for palpitations
You should seek immediate medical attention if palpitations are accompanied by severe chest pain, fainting, severe shortness of breath, or sudden weakness, as these may indicate a serious cardiac event. For palpitations that are recurrent but less severe, schedule evaluation with a primary care provider. Typical assessments include a focused history, physical exam, resting electrocardiogram (ECG), and sometimes ambulatory monitoring (Holter or event monitor) to capture intermittent rhythm disturbances. Other tests can include blood work (electrolytes, thyroid function), echocardiography, and exercise testing depending on findings. Your clinician will balance the likelihood of a benign cause with the need to rule out arrhythmias or structural heart disease.
Conclusion
Heart palpitations have many causes ranging from temporary triggers like caffeine or stress to arrhythmias and structural heart conditions. Paying attention to patterns, associated symptoms, and risk factors helps determine when palpitations are likely benign and when they require testing. If you experience new, persistent, or concerning symptoms alongside palpitations, a healthcare professional can provide appropriate evaluation and next steps.
