Heart Palpitations: Common Causes, What’s Normal and When to Worry

Feeling your heart pound, flutter or skip a beat is unsettling, but it’s usually harmless. Caffeine, stress, a big meal or a bad night’s sleep are common culprits. Occasionally palpitations point to a heart rhythm problem that needs treatment, so it’s worth knowing the signs.

Imagine lying in bed after a long day, three coffees and a stressful shift behind you. As the room goes quiet, you notice your heart thumping, then a strange “flip” in your chest, a pause, and a hard beat. You lie awake listening for it. Most of the time, this is an extra heartbeat that’s completely benign. But how do you know?

What palpitations feel like

• Pounding or a strong heartbeat
• Fluttering in the chest or neck
• A skipped or extra beat, often followed by a thump
• A fast heartbeat, regular or irregular

Common, usually harmless triggers

• Caffeine, energy drinks, alcohol, nicotine and some recreational drugs
• Stress, anxiety and panic attacks
• Exercise, dehydration and lack of sleep
• Hormonal changes in periods, pregnancy and menopause
• Some medicines, such as decongestants and asthma inhalers
• Fever, anaemia and an overactive thyroid

How palpitations are checked

A nurse or doctor will ask what happens, how long it lasts and what triggers it, then usually do an ECG (a recording of your heart’s electrical activity) and blood tests for things like anaemia and thyroid problems. Because palpitations come and go, you may wear a portable heart monitor for a day or more. Smartwatch ECG recordings can also be useful to show your doctor, but they don’t replace a proper assessment.

But when should you worry?

Call your emergency number if palpitations come with chest pain or tightness, severe breathlessness, fainting or nearly fainting, or confusion.

See a doctor or nurse soon if palpitations:

• Last a long time, keep coming back, or are getting worse
• Feel fast and irregular, which can be atrial fibrillation, a common rhythm problem that raises stroke risk
• Happen during exercise
• Occur in someone with a heart condition or a family history of sudden death at a young age

Sources: NHS (Heart palpitations), American Heart Association, British Heart Foundation, US National Heart, Lung, and Blood Institute. This guide is for general information and does not replace advice from your own nurse, doctor or emergency services.