Man holding chest
Palpitations are feelings that your heart is skipping a beat, fluttering or beating too hard or too fast. You may have these feelings in your chest, throat or neck. They can occur during activity or even when you’re sitting still or lying down.

What causes palpitations?

Many things can trigger palpitations, including:

  • Strong emotions
  • Vigorous physical activity
  • Medicines, such as diet pills and decongestants
  • Caffeine, alcohol, nicotine and illegal drugs
  • Certain medical conditions, such as thyroid disease or anemia (a low blood count).

These factors may make the heart beat faster or stronger than usual or they can cause occasional extra heartbeats. In these situations, the heart is still working normally and the palpitations usually are harmless.

Sometimes palpitations are symptoms of an arrhythmia, which is a problem with the rate or rhythm of the heartbeat. Some arrhythmias are signs of heart conditions, such as heart attack, heart failure, heart valve problems or heart muscle problems. However, fewer than half of the people who have palpitations have arrhythmias.

How are palpitations diagnosed?

Your doctor will first want to find out whether your palpitations are harmless or related to a more serious heart problem. To do this, he/she will ask about your symptoms and medical history, do a physical exam and recommend several basic diagnostic tests.

  • When did they begin?
  • How long do they last?
  • How often do they occur?
  • Do they start and stop suddenly?
  • Does your heartbeat feel steady or irregular during the palpitations?
  • What other symptoms do you have when you get palpitations
  • Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?
  • Do you use caffeine, alcohol, supplements or illegal drugs?

Your doctor will take your pulse to find out how fast your heart is beating and whether it’s beating with a normal rhythm. He/she will use a stethoscope to listen to your heartbeat. You’ll also be examined for other conditions (such as an overactive thyroid) that can cause palpitations. The cause of palpitations may be hard to diagnose, especially if symptoms don’t occur regularly. You may need to undergo several tests.

Diagnostic tests

Electrocardiogram (EKG)
Often, the first test that’s done is an EKG. This simple test records your heart’s electrical activity, including strength and timing of electrical signals as they pass through each part of your heart. It shows how fast your heart is beating and whether its rhythm is steady or irregular. Even if your EKG results are normal, you may still have a medical condition that’s causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart’s structure, function and electrical system. You may also need further diagnostic tests.

Holter monitor
A Holter monitor is a small device that records your heart rhythm. It has electrodes that are attached to your chest with adhesive and connected to a recording device. You usually wear a one for one to three days and during that time, the device will record all of your heartbeats. You’ll also be asked to keep a diary of your activities and any symptoms you noticed. Your doctor will compare the data from the recorder and the activities and symptoms you wrote down. If your heart rhythm changed while you completed strenuous activities or experienced symptoms, knowing that information can make a diagnosis.

An echocardiogram is a specialized ultrasound machine that creates a video image of the beating heart. This non-invasive test is often used to identify problems with heart muscle and valves.


Palpitations are very common. If they are caused by a medical condition, your doctor can determine what you need for treatment or ongoing care. They usually aren’t serious or harmful and will often go away on their own, but they can be bothersome. In that case, you may want to avoid common triggers:

  • Anxiety and stress (including panic attacks)
  • Stimulants, such as caffeine, nicotine, or alcohol
  • Illegal drugs, such as cocaine and amphetamines
  • Medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements

Heart disease questions

This information was made available by retired cardiothoracic surgeon Dr. Joan Tryzelaar. Dr. Tryzelaar created the website Cardiac Health and blog Ask Dr. T to help answer people’s questions about heart disease. Ask Dr. T was recognized as one of the Top 10 Heart Disease Blogs of 2012 by Healthline Network.

Ask Dr. T is now going to be a regular feature on the Catching Health blog. He will answer questions and may offer advice, but Dr. Tryzelaar will not be able to make any kind of diagnosis. Heart disease is the leading cause of death for both men and women in the United States. Coronary disease is the most common type of heart disease, but there are many more problems beyond heart attacks and clogged arteries.

Do you have a question for Dr. T about heart disease? Write it the comment section below or send an email to Catching Health.

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