Medically Reviewed By: Mark Aquino, NP – Urgent Care Nurse Practitioner, author of Physical Assessment for Nurses Simplified. This article is based on real-world urgent care experience and current clinical guidelines.
Heart palpitations can be unsettling. You may suddenly notice your heart pounding in your chest, fluttering, racing, or seemingly skipping a beat. Sometimes the sensation lasts only a few seconds. Other times it may continue for minutes or repeatedly come and go.
Fortunately, heart palpitations are common and are often not caused by a dangerous heart problem. Stress, anxiety, strenuous exercise, caffeine, nicotine, certain medications, lack of sleep, hormonal changes, and other factors can trigger them. However, palpitations can occasionally be caused by an abnormal heart rhythm or another medical condition that requires treatment.¹˒²
The most important question is not simply whether you can feel your heartbeat. It is what the palpitations feel like, how long they last, how often they occur, what triggers them, and whether other symptoms occur at the same time.
Heart palpitations accompanied by chest pain, significant shortness of breath, severe dizziness, fainting, or loss of consciousness require prompt emergency medical attention.¹˒²
This guide explains what heart palpitations feel like, common causes, possible abnormal heart rhythms, warning signs, and when you should choose primary care, urgent care, or the emergency room.
Medical disclaimer: This article is for general educational purposes and does not provide an individual diagnosis or replace evaluation by a qualified healthcare professional. If you are currently experiencing severe or persistent palpitations with chest pain, significant shortness of breath, fainting, or other concerning symptoms, seek emergency medical care.
What Are Heart Palpitations?
Heart palpitations are an increased or unusual awareness of your heartbeat.
People describe the sensation in many different ways. Your heart may feel like it is:
- Racing
- Pounding
- Fluttering
- Beating unusually hard
- Flip-flopping
- Skipping beats
- Having extra beats
- Beating irregularly
You may feel palpitations in your chest, throat, or neck, and they can happen while you are active or completely at rest.¹
Importantly, feeling palpitations does not necessarily mean your heart rhythm is abnormal.
A person can become very aware of a normal heartbeat during stress, exercise, anxiety, or after consuming stimulants. On the other hand, an abnormal rhythm can also produce palpitations.
Determining which situation is occurring sometimes requires an electrocardiogram (ECG/EKG) or longer-term heart-rhythm monitoring.³
What Causes Heart Palpitations?
There are many possible causes of palpitations, ranging from everyday triggers to heart-rhythm disorders.
Common triggers and causes include:
- Stress
- Anxiety or panic
- Strenuous exercise
- Lack of sleep
- Caffeine
- Nicotine
- Alcohol
- Fever
- Certain medications
- Some cold and cough medicines
- Hormonal changes
- Pregnancy
- Menopause
- Thyroid disease
- Anemia
- Electrolyte abnormalities
- Heart-rhythm disorders
Palpitations can also occur without an obvious cause.
The NHS notes that palpitations are common and are not usually a sign of something serious, but recurring or prolonged palpitations deserve medical evaluation.²
Can Caffeine Cause Heart Palpitations?
Caffeine can contribute to palpitations in some people, although sensitivity varies considerably.
Sources include:
- Coffee
- Tea
- Energy drinks
- Pre-workout supplements
- Certain sodas
- Some medications and supplements
If you notice that your palpitations consistently occur after consuming large amounts of caffeine, reducing your intake may help.
Energy drinks deserve particular attention because some contain substantial amounts of caffeine and other stimulants.
However, don’t automatically assume caffeine is responsible for new, persistent, or symptomatic palpitations, particularly if they occur with chest pain, fainting, severe dizziness, or shortness of breath.
Can Stress and Anxiety Cause Heart Palpitations?
Yes.
Strong emotional responses such as stress, anxiety, fear, and panic can cause palpitations.¹
When you experience stress, your body’s sympathetic nervous system becomes more active. Stress hormones can increase heart rate and the force of cardiac contractions, making your heartbeat much more noticeable.
Anxiety-related palpitations may occur with:
- A feeling of nervousness
- Trembling
- Sweating
- Rapid breathing
- Tingling
- A sense of impending danger
- Chest tightness
- Difficulty relaxing
However, there is an important caution:
Anxiety should not automatically be assumed to be the cause of palpitations.
Heart-rhythm disorders can produce sensations that feel frightening and can themselves trigger anxiety.
A healthcare professional may therefore evaluate the cardiac symptoms before concluding that recurrent palpitations are primarily anxiety-related, especially when the episodes are new or accompanied by concerning symptoms.
Can Lack of Sleep Cause Heart Palpitations?
Lack of sleep is another commonly recognized trigger for palpitations.²
Sleep deprivation can affect the autonomic nervous system and increase stress responses. People who are exhausted may also consume more caffeine or energy drinks, which can further contribute to symptoms.
If palpitations occur primarily during periods of poor sleep, improving sleep habits may help.
However, recurrent palpitations that continue despite adequate rest deserve further evaluation.
Why Do I Feel Heart Palpitations at Night?
Palpitations may seem especially noticeable at night or when lying in bed.
One reason is simple: during the day, you are surrounded by activity and distractions. At night, when the environment becomes quiet and you are lying still, you may become much more aware of your heartbeat.
Your body position can also make cardiac contractions easier to perceive.
Palpitations at night may also be associated with:
- Stress or anxiety
- Caffeine consumed later in the day
- Alcohol
- Nicotine
- Certain medications
- Premature beats
- Other heart-rhythm abnormalities
If nighttime palpitations repeatedly wake you, occur frequently, last for prolonged periods, or occur with other symptoms, discuss them with a healthcare professional.
Why Does My Heart Feel Like It Skipped a Beat?
People commonly describe palpitations as a sensation that their heart “skipped a beat.”
Sometimes this sensation is caused by a premature contraction, meaning an electrical impulse occurs earlier than expected.
These include:
- Premature atrial contractions (PACs)
- Premature ventricular contractions (PVCs)
After a premature beat, there may be a brief pause followed by a stronger contraction. That stronger beat can create the sensation that the heart stopped momentarily and then “thumped.”
Occasional premature beats can occur in otherwise healthy people.
However, frequent premature beats, new symptoms, or palpitations accompanied by dizziness, fainting, chest discomfort, or shortness of breath deserve medical evaluation.
An ECG or ambulatory monitor may be needed to determine exactly what rhythm is occurring during the symptoms.³˒⁴
Are PVCs Dangerous?
Premature ventricular contractions, commonly called PVCs, originate in the ventricles rather than from the heart’s usual electrical pathway.
PVCs can feel like:
- A skipped beat
- A sudden thump
- Fluttering
- A pause followed by a stronger beat
The significance of PVCs depends on factors such as their frequency, associated symptoms, and whether structural heart disease is present.
This means the question isn’t simply:
“Do I have PVCs?”
It is also:
“How frequent are they, are they actually responsible for my symptoms, and is there underlying heart disease?”
A clinician may use an ECG, ambulatory rhythm monitor, echocardiogram, or other testing when appropriate.³˒⁴
What Heart-Rhythm Problems Can Cause Palpitations?
An abnormal heart rhythm is called an arrhythmia.
Arrhythmias can cause the heart to beat:
- Too quickly
- Too slowly
- Irregularly
- In an abnormal electrical pattern
Potential rhythm-related causes of palpitations include several different types of tachyarrhythmias and premature beats.
One important example is atrial fibrillation, which produces abnormal electrical activity in the upper chambers of the heart and commonly causes an irregular rhythm.
Other people may experience episodes of supraventricular tachycardia (SVT), which can produce a very rapid heartbeat that may begin and stop abruptly.
More serious ventricular arrhythmias can also occur, particularly in people with underlying heart disease.
You cannot reliably identify the exact rhythm based solely on how the palpitations feel.
That is why capturing the heart’s electrical activity during an episode can be so useful.³
How Do I Know If My Heart Palpitations Are Serious?
Palpitations become more concerning when they occur with symptoms suggesting that the heart may not be maintaining adequate circulation or that another significant cardiopulmonary problem may be occurring.
Seek emergency medical attention for palpitations accompanied by:
- Chest pain or significant chest discomfort
- Significant shortness of breath
- Fainting or loss of consciousness
- Severe dizziness or lightheadedness
- Persistent severe symptoms
These are specifically identified as emergency warning signs by major medical references.¹˒²
Your medical history also matters.
Recurrent palpitations may deserve more extensive evaluation in people with known heart disease, abnormal previous ECG findings, structural heart disease, or a concerning family history.³˒⁴
Heart Palpitations With Chest Pain
Palpitations accompanied by chest pain require particular attention.
Chest discomfort can occur for many reasons, but it can also be associated with significant cardiac problems.
If palpitations occur with new, severe, persistent, or concerning chest pain, especially with sweating, shortness of breath, fainting, or significant weakness, seek emergency medical attention.
For more information about distinguishing potentially serious chest symptoms, read our guide to chest pain and when to worry.
Do not delay emergency evaluation in order to read online information if you are currently experiencing concerning chest pain.
Heart Palpitations With Shortness of Breath
Palpitations can sometimes make people feel briefly breathless, particularly during anxiety or rapid heart rates.
However, significant shortness of breath occurring with palpitations is an emergency warning sign, particularly when symptoms are severe or persistent.¹˒²
Potential causes extend beyond arrhythmias and can involve cardiac, pulmonary, metabolic, or other medical conditions.
See our related guide on shortness of breath and when to worry for additional warning signs and guidance on choosing urgent care versus the emergency room.
Heart Palpitations With Dizziness
Mild lightheadedness can occur for many reasons, but significant dizziness accompanying palpitations deserves attention.
A sufficiently fast or abnormal heart rhythm can sometimes reduce effective blood flow and cause:
- Lightheadedness
- Weakness
- Near-fainting
- Fainting
Severe dizziness with palpitations is an emergency warning sign.¹
If your primary symptom is dizziness, see our guide to dizziness and when to worry.
Heart Palpitations With Fainting
Palpitations associated with fainting or loss of consciousness are more concerning than isolated brief palpitations.
An abnormal rhythm can occasionally cause blood pressure to fall enough that the brain temporarily receives inadequate blood flow.¹
Other cardiovascular and neurological problems can also cause fainting.
If you are currently experiencing palpitations with fainting, particularly if the symptoms are new or unexplained, seek emergency medical attention.
Can Dehydration Cause Heart Palpitations?
Significant fluid loss can contribute to changes in heart rate and circulation.
Dehydration may occur after:
- Vomiting
- Diarrhea
- Heavy sweating
- Prolonged heat exposure
- Inadequate fluid intake
A person who becomes volume depleted may notice a faster heartbeat, particularly when standing or exerting themselves.
Vomiting and diarrhea can also sometimes contribute to electrolyte abnormalities, which may affect heart rhythm in more significant cases.
If palpitations occur after substantial vomiting or diarrhea, particularly with severe weakness, fainting, inability to drink, or significant dizziness, medical evaluation may be necessary. Also see nausea and vomiting and when to worry.
Can Medications Cause Heart Palpitations?
Yes.
Some prescription and over-the-counter medications can trigger or worsen palpitations.
Examples include certain:
- Decongestants
- Stimulant medications
- Asthma medications
- Weight-loss products
- Supplements
Pseudoephedrine and other stimulant-containing cold medications are common examples.¹˒⁵
If palpitations began shortly after starting a new medication or increasing its dose, review the medication information and contact your healthcare professional or pharmacist.
Do not abruptly discontinue an important prescription medication without appropriate medical guidance unless you have been specifically instructed to do so.
Bring or provide a complete medication and supplement list when you are evaluated for palpitations.
Can Thyroid Problems Cause Palpitations?
Yes.
An overactive thyroid, or hyperthyroidism, can increase heart rate and contribute to palpitations.¹˒²
Other symptoms can include:
- Heat intolerance
- Tremor
- Unexplained weight loss
- Increased sweating
- Anxiety or restlessness
- Difficulty sleeping
- Increased bowel movements
Depending on the clinical situation, a healthcare professional may order thyroid testing when evaluating unexplained recurrent palpitations.
Can Anemia Cause Heart Palpitations?
Yes.
Iron-deficiency anemia and other forms of anemia can contribute to palpitations. The NHS lists iron-deficiency anemia among medical conditions that can cause them.²
When the blood’s oxygen-carrying capacity is reduced, the cardiovascular system may compensate by increasing cardiac output.
Other symptoms may include:
- Fatigue
- Weakness
- Shortness of breath with exertion
- Dizziness
- Pale skin
- Reduced exercise tolerance
A complete blood count may be considered during evaluation when anemia is clinically suspected.
Can Hormones Cause Heart Palpitations?
Hormonal changes can contribute to palpitations.
They may occur during:
- Pregnancy
- Menstruation
- Menopause
Both Mayo Clinic and the NHS recognize hormonal changes as potential contributors.¹˒²
However, pregnancy and the postpartum period also involve important physiological changes and can be associated with other cardiovascular conditions.
New or severe palpitations during pregnancy or postpartum—especially with chest pain, significant shortness of breath, fainting, or other concerning symptoms—should receive appropriate medical evaluation rather than automatically being attributed to hormones.
Are Heart Palpitations the Same as a Fast Heart Rate?
Not necessarily.
Palpitations describe what you feel. They are a symptom.
Heart rate describes how quickly the heart is actually beating.
You can experience palpitations even when your measured heart rate is within a typical range.
Conversely, someone can have an abnormal rhythm without strongly perceiving it.
A heart rate above 100 beats per minute is generally termed tachycardia, but context matters.⁵
A heart rate can appropriately rise above 100 during:
- Exercise
- Fever
- Stress
- Anxiety
- Pain
Therefore, a single number doesn’t determine whether a rapid heartbeat is dangerous.
Healthcare professionals interpret the heart rate together with the rhythm, symptoms, medical history, vital signs, and clinical circumstances.
What If My Heart Suddenly Starts Racing and Then Stops?
A sudden onset and sudden termination of a rapid heartbeat can occur with certain arrhythmias, including some forms of supraventricular tachycardia.
However, symptoms alone cannot reliably determine the rhythm.
If these episodes repeatedly occur, recording the heart rhythm during an episode becomes particularly valuable.
A standard ECG may be completely normal if the episode has already ended.
For intermittent symptoms, a healthcare professional may therefore recommend longer-term ambulatory monitoring.³˒⁴
How Are Heart Palpitations Diagnosed?
Evaluation usually begins with a detailed medical history and physical examination.
A healthcare professional may ask:
- When did the palpitations begin?
- How long do they last?
- How frequently do they happen?
- Do they start and stop suddenly?
- Does the heartbeat feel regular or irregular?
- Does it feel fast, pounding, fluttering, or like skipped beats?
- Do symptoms occur during exercise?
- Do they occur while resting?
- Do they wake you from sleep?
- Are you having chest pain?
- Do you become short of breath?
- Do you feel dizzy or faint?
- Have you actually lost consciousness?
- How much caffeine do you consume?
- Do you use nicotine?
- What medications and supplements do you take?
- Do you have thyroid disease?
- Do you have known heart disease?
- Is there a family history of arrhythmia or sudden cardiac death?
This information can substantially narrow the differential diagnosis.
Do You Need an EKG for Heart Palpitations?
An electrocardiogram (ECG or EKG) records the heart’s electrical activity.
It can identify abnormalities involving:
- Heart rate
- Heart rhythm
- Electrical conduction
- Certain structural or ischemic clues
Recent American Family Physician guidance recommends a 12-lead ECG as part of the initial evaluation of patients presenting with palpitations.³
However, there is an important limitation:
A normal EKG does not necessarily mean the palpitations never occurred.
If your symptoms are intermittent and your heart rhythm has returned to normal before the ECG is performed, the test may not capture the event.
That is where ambulatory monitoring becomes useful.
What Is a Holter Monitor?
A Holter monitor is a portable ECG device worn during normal daily activities.
It continuously records heart rhythm over a period of time and may detect abnormalities that were absent during a brief office ECG.⁶
If symptoms occur less frequently, a clinician may choose a longer-duration event monitor or another ambulatory monitoring strategy.
The objective is straightforward:
Capture the heart rhythm while the patient is actually experiencing the palpitation.
That can establish whether the sensation corresponds to:
- Normal rhythm
- Premature beats
- Atrial fibrillation
- Tachycardia
- Another arrhythmia
Ambulatory ECG monitoring remains a major component of evaluating unexplained intermittent palpitations.³
Can a Smartwatch Detect Heart Palpitations?
Some consumer smartwatches can measure heart rate and some can record a single-lead ECG.
These devices may help identify certain rhythm abnormalities, particularly atrial fibrillation, and can provide useful information to healthcare professionals.³
However, a smartwatch has important limitations.
It can:
- Miss brief arrhythmias
- Produce false-positive alerts
- Misinterpret motion or poor signal quality
- Fail to identify some clinically important rhythms
A smartwatch should therefore be viewed as a potential source of useful information, not a substitute for medical evaluation or a standard 12-lead ECG.
If your watch reports an abnormal rhythm and you have chest pain, severe shortness of breath, fainting, or severe dizziness, seek medical care based on your symptoms rather than repeatedly checking the watch.
What Other Tests Might Be Ordered for Palpitations?
Testing depends on the history and examination.
In addition to an ECG and ambulatory monitoring, clinicians may consider:
- Complete blood count
- Electrolytes
- Thyroid testing
- Other laboratory studies
- Echocardiogram
- Exercise stress testing
- Cardiology evaluation
An echocardiogram uses ultrasound to evaluate the heart’s structure and function. It may be appropriate when the history, physical examination, or ECG raises concern for structural heart disease.³˒⁶
Not everyone with palpitations needs every test.
The evaluation should be targeted to the clinical situation.
When Should You Go to Urgent Care for Heart Palpitations?
Urgent care may be appropriate for stable patients with palpitations who need timely evaluation but do not have obvious emergency warning signs.
Examples can include:
- New intermittent palpitations
- Recurring skipped-beat sensations
- Palpitations lasting longer than usual but currently stable
- Palpitations after caffeine or medication exposure
- Palpitations without chest pain, significant shortness of breath, severe dizziness, or fainting
- A need for an ECG when the patient otherwise appears clinically stable
An urgent care clinic may be able to:
- Check vital signs
- Perform a cardiovascular examination
- Obtain a 12-lead ECG
- Review medications and stimulants
- Assess for other causes
- Determine whether emergency evaluation is necessary
However, capabilities vary considerably between urgent care centers.
Some clinics cannot perform extended cardiac monitoring, echocardiography, advanced laboratory testing, or emergency cardiac interventions.
A patient whose evaluation raises concern for a significant arrhythmia or other serious cardiovascular condition may therefore be transferred or referred to the emergency department.
When Should Heart Palpitations Go to the ER?
Seek emergency medical care if you currently have palpitations that **do not resolve or are accompanied by:**¹˒²
- Chest pain or significant chest discomfort
- Significant or severe shortness of breath
- Fainting or loss of consciousness
- Severe dizziness or lightheadedness
Other concerning situations include a sustained very rapid or markedly abnormal heartbeat accompanied by weakness, low blood pressure, altered mental status, or other signs that you are clinically unstable.
Do not drive yourself if you are fainting, severely dizzy, experiencing significant chest pain, or otherwise potentially unstable. Also see chest tightness at night and what it means.
What Can You Do at Home for Occasional Heart Palpitations?
If you have already been medically evaluated when appropriate and your palpitations are believed to be benign, identifying and reducing triggers may help.
Potential measures include:
- Reduce excessive caffeine.
Pay attention to coffee, energy drinks, pre-workout supplements, tea, and other caffeine sources. - Avoid nicotine.
Nicotine is a stimulant and can contribute to palpitations. - Review cold medicines.
Some decongestants contain stimulants such as pseudoephedrine.¹ - Get adequate sleep.
Sleep deprivation is a recognized trigger for some people.² - Stay appropriately hydrated.
This is particularly relevant during heat exposure, strenuous exercise, vomiting, or diarrhea. - Manage stress.
Relaxation techniques and slow breathing may help when stress contributes to symptoms.¹ - Keep a symptom diary.
Record when palpitations occur, how long they last, your activity at the time, associated symptoms, caffeine or medication exposure, and your heart rate if available.
Avoid self-treating unexplained recurrent palpitations with someone else’s heart medication or supplements marketed as “heart rhythm” treatments.
The correct treatment depends on the underlying cause.
How Are Heart Palpitations Treated?
There is no single treatment for palpitations because palpitations are a symptom, not a diagnosis.
Treatment may involve:
Trigger modification
If caffeine, nicotine, medications, stress, or another trigger is responsible, reducing the trigger may substantially improve symptoms.¹
Treating an underlying medical condition
For example, treatment may be directed toward:
- Hyperthyroidism
- Anemia
- Electrolyte abnormalities
- Other systemic conditions
Treating an arrhythmia
Depending on the rhythm and clinical situation, treatment may include:
- Medications
- Rate or rhythm control
- Catheter ablation
- Other cardiac procedures
The appropriate management depends entirely on the specific rhythm and the patient’s underlying health.³
Can Heart Palpitations Cause a Stroke?
Palpitations themselves do not cause a stroke.
However, some arrhythmias that cause palpitations can increase stroke risk.
Atrial fibrillation is an important example. When the upper chambers of the heart do not contract normally, blood can pool and form clots. A clot can then travel to the brain and cause an ischemic stroke.¹
This does not mean that every flutter or skipped beat indicates atrial fibrillation.
The rhythm needs to be identified appropriately before conclusions are made about stroke risk or treatment.
Can Heart Palpitations Cause Cardiac Arrest?
Most palpitations do not lead to cardiac arrest.
However, rare dangerous arrhythmias can prevent the heart from pumping blood effectively and may result in cardiac arrest.¹
This is one reason palpitations accompanied by fainting, severe dizziness, chest pain, or significant shortness of breath should not be ignored.
The presence of palpitations alone does not mean cardiac arrest is imminent.
Frequently Asked Questions About Heart Palpitations
Are heart palpitations usually dangerous?
No. Palpitations are common and often benign. Stress, exercise, stimulants, medications, and other non-dangerous factors frequently cause them.¹˒²
However, recurring or prolonged palpitations should be evaluated, particularly when associated with other symptoms or known heart disease.
What do heart palpitations feel like?
People commonly describe racing, pounding, fluttering, flip-flopping, skipped beats, or extra beats. The sensation may occur in the chest, neck, or throat.¹˒²
Why is my heart fluttering?
Fluttering can result from increased awareness of a normal heartbeat, premature beats, stress, stimulants, or an arrhythmia.
The sensation alone cannot determine the rhythm.
Why does my heart skip a beat?
A premature contraction can create a skipped-beat sensation. After the premature beat, the next contraction may feel stronger.
Occasional premature beats can occur in healthy people, but new or frequent symptoms deserve evaluation when appropriate.
Can anxiety cause palpitations all day?
Anxiety can contribute to recurrent palpitations, but persistent symptoms should not automatically be attributed to anxiety without considering other causes.
A healthcare professional may assess the history, examination, ECG, medications, thyroid status, anemia risk, and other factors depending on the situation.
Are palpitations at night dangerous?
Not necessarily. Palpitations may simply become more noticeable when you are lying quietly.
However, recurring nighttime episodes, prolonged symptoms, or palpitations associated with chest pain, significant shortness of breath, severe dizziness, or fainting should be evaluated.
Should I go to urgent care for heart palpitations?
Urgent care can be appropriate for stable new or recurring palpitations without emergency symptoms, particularly if an ECG or clinical evaluation is needed.
If you have palpitations with chest pain, significant shortness of breath, fainting, or severe dizziness, emergency evaluation is more appropriate.¹˒²
Can dehydration cause a racing heart?
Fluid depletion can contribute to an increased heart rate, especially during illness, heat exposure, vomiting, diarrhea, or heavy sweating.
Persistent tachycardia or palpitations with severe weakness, fainting, or other concerning symptoms should be medically evaluated.
How long is too long for heart palpitations?
There isn’t a universal number of minutes that separates harmless from dangerous palpitations.
Brief, infrequent palpitations lasting only seconds often require less evaluation, while recurrent episodes, episodes lasting longer, or worsening symptoms deserve medical attention.¹˒²
Associated symptoms are especially important.
What if my EKG is normal but I still get palpitations?
A normal ECG only records your heart’s electrical activity during the short period when the test is performed.
If your palpitations are intermittent, your rhythm may have returned to normal before the ECG.
Ambulatory monitoring, such as a Holter or event monitor, may help correlate future symptoms with your actual heart rhythm.³˒⁶
The Bottom Line: When Should You Worry About Heart Palpitations?
Heart palpitations are common and most are not caused by a dangerous heart problem.
Stress, anxiety, exercise, caffeine, nicotine, sleep deprivation, medications, hormonal changes, and other factors can make your heartbeat feel unusually noticeable.¹˒²
However, recurrent palpitations can also result from medical conditions such as thyroid disease, anemia, electrolyte abnormalities, or an arrhythmia.
The most important distinction is whether the palpitations occur alone or with warning symptoms.
Seek emergency medical attention if palpitations are accompanied by:
- Chest pain
- Significant shortness of breath
- Fainting
- Severe dizziness or lightheadedness
For new, recurring, or increasingly frequent palpitations without emergency symptoms, primary care or urgent care can evaluate your history, medications, vital signs, and heart rhythm.
A standard ECG is an important part of the initial evaluation, but intermittent symptoms may require longer-term rhythm monitoring to determine exactly what your heart is doing during an episode.³
Don’t diagnose palpitations based solely on how they feel.
Identifying the actual rhythm—and considering the symptoms occurring with it—is what determines whether heart palpitations are harmless or need further treatment.
Medical References
1. Mayo Clinic. Heart Palpitations — Symptoms and Causes.
Supports descriptions of palpitations, common triggers, arrhythmias, emergency symptoms and potential cardiac complications.
Mayo Clinic — Heart Palpitations: Symptoms and Causes
2. NHS. Heart Palpitations. Updated March 17, 2026.
Supports common triggers, associated medical conditions, indications for routine evaluation and emergency warning symptoms.
NHS — Heart Palpitations
3. Gauer RL, Thomas MF, McNutt RA. Palpitations: Evaluation, Management, and Wearable Smart Devices. American Family Physician. 2024;110(3):259-269.
Supports 12-lead ECG evaluation, ambulatory monitoring, assessment for structural heart disease, wearable devices and management according to etiology.
American Family Physician — Palpitations: Evaluation, Management, and Wearable Smart Devices
4. American Academy of Family Physicians. Palpitations and Monitoring. FP Essentials. 2026.
Supports the differential diagnosis, ECG evaluation, ambulatory monitoring and echocardiography when structural disease is suspected.
AAFP — Palpitations and Monitoring
5. MedlinePlus, U.S. National Library of Medicine. Heart Palpitations.
Supports definitions of tachycardia, potential causes including stimulants and medications, and warning symptoms requiring medical evaluation.
MedlinePlus — Heart Palpitations
6. Mayo Clinic. Heart Palpitations — Diagnosis and Treatment.
Supports ECG, Holter monitoring, event recording, echocardiography and trigger modification.
Mayo Clinic — Heart Palpitations: Diagnosis and Treatment
About the author: Mark Aquino MSN, FNP-C. Mark has a Masters of Science in Nursing from West Coast University and is a board certified family nurse practitioner with over 8 years of real world experience in healthcare and currently practicing in urgent care diagnosing and prescribing treatments in California, USA. He is author of the book Physical Assessment for Nurses Simplified.