Heart palpitations: when to worry and when not to

Feeling your heart beat differently can be unsettling. Many people describe it as a racing, pounding, fluttering, or “skipping” sensation in the chest — sometimes even felt in the neck. These sensations are called heart palpitations, and they are one of the most common reasons people visit their doctor or cardiologist.

The good news is that most palpitations are harmless. However, they should always be checked, especially if they are new, frequent, or worrying.

What do palpitations feel like?

Palpitations can feel different from person to person. You may notice:

• A fast or strong heartbeat

• A fluttering or flip-flopping sensation

• The feeling that your heart has skipped a beat

Some people feel palpitations during stress or anxiety, before an important event, during exercise, or at night when lying quietly in bed.

What causes heart palpitations?

Palpitations can have many triggers, including:

• Stress, anxiety, or strong emotions

• Physical exertion or fatigue

• Caffeine, alcohol, or nicotine

• Low blood sugar

• Hormonal changes

• Thyroid problems

• Certain medications (such as inhalers or cold remedies)

• Heart rhythm disturbances

Often, palpitations occur without any serious heart problem.

What should you do if you have palpitations?

If palpitations keep happening or don’t go away, it’s important to speak with your doctor. An initial assessment usually includes:

• A medical history and physical examination

• An electrocardiogram (ECG) to check the heart’s rhythm

If the ECG is normal but symptoms continue, your doctor may recommend a heart monitor worn for several days or weeks to capture the rhythm during symptoms.

When palpitations need urgent attention

Palpitations can rarely be a sign of something serious, especially if they occur together with other symptoms. Seek urgent medical help if palpitations are accompanied by:

• Chest pain or pressure

• Shortness of breath

• Dizziness or fainting

• Sweating, nausea, or pain spreading to the arms, neck, jaw, or back

  
  

Can lifestyle changes help?

If no underlying heart condition is found, simple changes can often reduce palpitations:

• Limit caffeine and alcohol

• Avoid smoking or nicotine products

• Review medications with your doctor

• Manage stress through exercise, relaxation techniques, or mindfulness

Some people are also taught simple physical techniques (called vagal maneuvers) that can help slow the heart rate in certain situations.

When treatment is needed

If palpitations are caused by a medical condition — such as an abnormal heart rhythm, thyroid disease, or atrial fibrillation — treatment focuses on managing the underlying cause. This may involve medication or further testing, depending on the diagnosis.

The bottom line

Heart palpitations are common and usually not dangerous. Still, they should never be ignored. A proper evaluation can provide reassurance — or identify a problem early, when it’s easiest to treat. If you’re experiencing frequent or troubling palpitations, a simple heart rhythm assessment can help clarify what’s going on.

Reference (inspiration): Harvard Health Publishing – Harvard Heart Letter