01 · Overview
The short version
The feeling is real, but the cause can vary
Palpitations can happen with a normal rise in heart rate, a harmless extra beat, or an arrhythmia. The sensation alone cannot tell you which one it is.
The pattern gives useful clues
When it starts, how long it lasts, and what you were doing right before it began can help a clinician decide whether the cause is likely temporary or more serious.
Chest pain, fainting, or breathing trouble changes the urgency
Palpitations with chest pain, shortness of breath, fainting, or confusion need emergency attention because they can signal a dangerous rhythm problem or another emergency.
A normal EKG does not always end the workup
If episodes come and go, the rhythm may not be happening during the test. A longer monitor, blood tests, or other heart testing may still be needed.
02 · Care guidance
When to get help
Emergency help
- Call 911 now if palpitations come with chest pain, severe shortness of breath, fainting, confusion, or signs of stroke.
- Get emergency care right away if your heartbeat is very fast and does not slow down, or if palpitations happen with known heart disease and you feel weak, sweaty, or lightheaded.
Get advice promptly
- Contact a clinician promptly if palpitations are new, happen often, last longer than a few minutes, or are becoming more noticeable.
- Make an appointment soon if palpitations happen with dizziness, exercise intolerance, thyroid symptoms, anemia symptoms, or a family history of rhythm problems or sudden cardiac death.
If you feel well otherwise and the episodes are brief and rare, keep a symptom log and bring it to a primary care visit. That record can help decide whether you need an EKG, blood tests, or a heart monitor.
03 · Heart Palpitations
What the heartbeat sensation can feel like
Palpitations describe the feeling, not the diagnosis. The same sensation can come from an extra beat, a fast rhythm, or something outside the heart.
People often describe palpitations as fluttering, pounding, racing, thumping, or a skipped beat. Some notice a brief pause followed by a stronger thump. Others feel the heartbeat in the chest, throat, or neck. The key detail is not just how it feels, but whether the pulse is fast, slow, or irregular when it happens.
Arrhythmia is the medical term for a problem with the rate or rhythm of the heartbeat. It can mean the heart beats too quickly, too slowly, or with an irregular pattern. Some arrhythmias are harmless, especially when the heart rate rises with exercise and slows during sleep. Others can reduce how well the heart pumps blood.
- Write down whether the beat felt fast, irregular, or like single skipped beats.
- Note the time, how long it lasted, and what you were doing before it started.
- If you had chest pain, dizziness, fainting, or shortness of breath, treat that as a more serious event.
04 · Heart Palpitations
Common reasons the heart feels jumpy
Many palpitations come from temporary triggers, but repeated episodes can point to a rhythm disorder or another health problem.
Stress, strong emotion, nicotine, alcohol, illegal drugs, and some medicines can trigger palpitations. Fever, dehydration, poor sleep, and heavy exercise can also make the heartbeat feel more noticeable. MedlinePlus also lists certain health conditions that raise risk, including heart and blood vessel disease, lung disease, kidney disease, obesity, and sleep apnea.
Heart-related causes include premature beats, supraventricular tachycardia, and atrial fibrillation. Atrial fibrillation matters because the heart's upper and lower chambers do not work together normally, so the lower chambers may not fill or pump well. That can cause a pounding heartbeat, dizziness, fatigue, or trouble breathing.
Some people have palpitations without an obvious trigger, and sometimes the cause is not found right away. That does not mean the symptom should be ignored. It means the rhythm may need to be captured during an episode, or other causes such as thyroid disease or anemia may need to be checked.
- Think about recent caffeine, alcohol, nicotine, cannabis, or stimulant use.
- Review prescription and over-the-counter medicines, including decongestants.
- If you have known heart disease, new palpitations deserve faster review.
05 · Heart Palpitations
When a pounding heartbeat is a warning sign
Palpitations need urgent care when they come with signs that the heart may not be pumping well enough or another emergency is unfolding.
Get emergency care if palpitations happen with chest pain, shortness of breath, fainting, confusion, or signs of stroke. These symptoms can mean the rhythm problem is affecting blood flow, or that the chest symptoms come from a heart attack or another urgent condition.
A very fast heartbeat that does not slow down is also concerning, especially if you feel weak, sweaty, or lightheaded. If you already have heart disease and the palpitations are new or much worse, that lower threshold for urgent care matters because the heart may be under strain.
If the episodes stop but keep coming back, that still deserves follow-up. A person may feel better between episodes and still have a rhythm problem that needs treatment.
- Do not drive yourself if you feel faint, weak, or have chest pain.
- Call 911 or local emergency services if symptoms are ongoing or severe.
- If the episode passes but keeps recurring, arrange prompt medical review.
06 · Heart Palpitations
What an appointment is usually trying to catch
Clinicians try to capture the rhythm during symptoms or find a condition that could be driving them.
The visit usually starts with questions about what the heartbeat feels like, how long episodes last, what you were doing before they started, and whether you have chest pain, dizziness, fainting, breathlessness, or swelling. A pulse check and physical exam can give clues about rhythm and overall heart function.
An EKG is a common first test because it records the heart's electrical activity at that moment. If episodes are brief or happen only sometimes, a longer heart monitor may be more useful because a normal EKG between episodes does not rule out an arrhythmia. Blood tests may be ordered to look for thyroid disease, anemia, or other contributors. An echocardiogram may be used if there is concern about a structural heart problem.
This is why bringing a symptom log helps. A record of timing, triggers, and associated symptoms can make it more likely that the right test is chosen the first time.
- Bring a list of medicines, supplements, and substances you use.
- Record when the episodes happen, how long they last, and what you were doing.
- If possible, save any wearable or pulse readings from the episode.
07 · Heart Palpitations
What to track while you wait for care
A short log can reveal patterns, but it should not delay care if warning signs appear.
Write down the date, time, duration, activity, recent food or drink, medicines, and any symptoms that happened with the palpitations. Helpful details include caffeine, alcohol, nicotine, cannabis, decongestants, inhalers, missed medicines, heavy exercise, fever, illness, or poor sleep. The point is not to become your own diagnostician. It is to help a clinician see a pattern that is hard to remember later.
If stress seems involved, simple calming steps may make episodes less noticeable. That can be useful, but only when there are no warning signs. If the episodes are getting more frequent, lasting longer, or starting to affect sleep, activity, or your sense of balance, that is a reason to move from self-monitoring to medical evaluation.
- Keep the log brief and specific.
- Bring medication names instead of only describing them.
- Do not use symptom tracking to delay urgent care if red flags appear.
08 · FAQ
Questions people ask
Can anxiety cause heart palpitations?
Yes. Strong emotion and stress can trigger a racing or pounding heartbeat. But anxiety should not be assumed to be the only cause, especially if the episodes are new, severe, or come with chest pain, fainting, or shortness of breath. Those symptoms need evaluation because an arrhythmia or another heart problem can feel similar.
Can caffeine, nicotine, or alcohol make palpitations worse?
They can in some people. Caffeine, energy drinks, nicotine, alcohol, and some stimulant medicines can make the heartbeat feel fast or shaky. If the timing fits, reducing or avoiding the trigger is reasonable while you arrange care if the episodes are frequent or changing. If symptoms are severe, do not treat this as a simple trigger problem.
Should I stop my medicine if I think it is causing palpitations?
Do not stop a prescribed medicine suddenly on your own. Some medicines should not be stopped abruptly, and changing them the wrong way can create new risks. Bring the medicine name, dose, and when the symptoms began to a clinician so they can decide whether a safer substitute or dose change makes sense.
What tests are commonly used for palpitations?
An EKG is often the first test, and blood tests may be ordered to look for thyroid disease, anemia, or other contributors. If the episodes come and go, a heart monitor may be needed to catch the rhythm during symptoms. An echocardiogram may be added if a structural heart problem is suspected.
Do palpitations mean I have atrial fibrillation?
Not necessarily. AFib is one possible cause, but palpitations can also come from extra beats, other arrhythmias, stress, or non-heart causes. AFib is important to rule in or out because it can raise stroke risk, but the symptom itself does not prove that diagnosis.
When should I keep track of palpitations instead of calling right away?
If you feel well otherwise and the episodes are brief, rare, and not linked with warning signs, a symptom log is a reasonable first step while you arrange a routine visit. If the episodes are new, frequent, lasting longer, or tied to dizziness, chest pain, fainting, or shortness of breath, do not wait on home tracking alone.
09 · References
References and supporting evidence
These sources support the points identified below. Source checking is not clinical approval.
- S1: ArrhythmiaMedlinePlus / U.S. National Library of Medicine
Explains that arrhythmias can change the heartbeat rate or rhythm, which is the medical background for palpitations. Supports the emergency triage language that palpitations with chest pain or shortness of breath need urgent medical attention. Supports the description of what an evaluation visit involves, including questions about symptoms and triggers. Supports the use of EKG as a common first test for palpitations or suspected arrhythmia.
- S2: Atrial FibrillationMedlinePlus / U.S. National Library of Medicine
Explains that atrial fibrillation can feel like a pounding heartbeat and can also cause dizziness or fatigue. Supports the statement that atrial fibrillation matters because it can increase stroke risk and needs timely evaluation. Supports the idea that a longer monitor may be used when episodes are intermittent and not caught on a short EKG.
- S3: Heart DiseasesMedlinePlus / U.S. National Library of Medicine
Explains that heart disease includes arrhythmia, supporting the distinction that palpitations may relate to broader heart disease, not only a benign sensation.
General information, not a diagnosis. This guide is not a substitute for care from a qualified healthcare professional. For an emergency, call 911 in the US or your local emergency number. Illustrations are conceptual and are not diagnostic images.