Understanding Heart Palpitations: Causes 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 describe a range of sensations: a rapid heartbeat, skipped beats, a strong thump, or a fluttering feeling in the chest. They can originate from the heart’s electrical system or be triggered by signals outside the heart, such as hormones or stimulants. Palpitations are subjective — what one person notices as intense might be barely perceptible to another. Common immediate causes include caffeine, nicotine, certain medications, dehydration, and vigorous exercise. Less frequently, palpitations reflect rhythm problems (arrhythmias) that warrant a medical evaluation.

Why do palpitations affect the chest?

The chest houses the heart, so the perception of palpitations is often localized there. Some people feel palpitations in the throat, neck, or upper chest depending on body position and how the heart’s contractions transmit through surrounding tissues. Structural heart conditions, like valve issues or enlarged chambers, can alter how forceful a beat feels. Non-cardiac causes — such as acid reflux or muscle spasms — can also create sensations that mimic palpitations in the chest. A focused history and physical exam help clinicians differentiate cardiac from non-cardiac origins.

How are palpitations linked to anxiety?

Anxiety can both cause and amplify palpitations. During anxiety or panic, the body activates the sympathetic nervous system, releasing adrenaline that raises heart rate and can create fluttering or pounding sensations. People with anxiety disorders may be more attuned to bodily sensations and therefore more likely to notice palpitations. Conversely, frequent unexplained palpitations may provoke anxiety, creating a feedback loop. Addressing anxiety through therapy, breathing techniques, or, when appropriate, medication can reduce the frequency and distress associated with palpitations.

Can stress cause heart palpitations?

Acute and chronic stress are known triggers for palpitations. Short-term stress increases catecholamines (like adrenaline), which speed heart rate and may provoke irregular beats. Long-term stress can contribute to lifestyle factors — poor sleep, increased caffeine or alcohol use, and reduced exercise — that raise the likelihood of palpitations. Managing stress with techniques such as progressive muscle relaxation, structured physical activity, sleep hygiene, and time management can lower both baseline arousal and episodes of palpitations for many people.

When to seek care for heart palpitations?

Most palpitations are harmless, but certain features suggest the need for prompt medical evaluation: palpitations accompanied by chest pain, fainting or near-fainting, shortness of breath, dizziness, or those that are frequent and worsening. People with known heart disease, a family history of sudden cardiac events, or very fast or irregular rhythms should contact a healthcare professional. A clinician may recommend monitoring with an ECG, Holter monitor, event recorder, or further testing such as an echocardiogram or blood work to check thyroid function and electrolytes. Treatment varies from reassurance and lifestyle change to medications or procedures for specific arrhythmias.

Conclusion

Heart palpitations are a common symptom with a wide range of causes, including stimulants, structural heart issues, anxiety, and stress. Understanding the context of palpitations — how they feel, when they occur, and what other symptoms accompany them — helps determine whether home management or medical evaluation is appropriate. If palpitations are causing significant concern or are paired with warning signs, a medical assessment can clarify the cause and guide safe management.