Heart palpitations

Normally the heart beats 60 to 100 times per minute. The rate may drop below 60 beats per minute in people who exercise regularly or take medicines that slow the heart.

If your heart rate is fast (over 100 beats per minute), this is called tachycardia. A heart rate slower than 60 is called bradycardia. An occasional extra heartbeat out of rhythm is known as extrasystole.

Palpitations are not serious most of the time. Sensations representing an abnormal heart rhythm (arrhythmia) may be more serious.

The following conditions make you more likely to have an abnormal heart rhythm:

• Known heart disease at the time the palpitations begin
• Significant risk factors for heart disease
• An abnormal heart valve
• An electrolyte abnormality in your blood -- for example, a low potassium level

Heart palpitations can be due to:

• Anxiety, stress, panic attack, or fear
• Caffeine intake
• Cocaine, methamphetamine or other stimulant drugs
• Decongestant medications, such as phenylephrine or pseudoephedrine
• Diet pills
• Exercise
• Fever
• Nicotine intake
• Excessive alcohol consumption

However, some palpitations are due to an abnormal heart rhythm, which may be caused by:

• Heart disease
• Abnormal heart valve, such as mitral valve prolapse
• Abnormal blood level of potassium
• Certain medicines, including those used to treat asthma, high blood pressure, or heart problems
• Overactive thyroid
• Low level of oxygen in your blood

Things you can do to limit palpitations include:

• Lower your intake of caffeine, nicotine, or other stimulants. This will often reduce heart palpitations.
• Learn to reduce stress and anxiety. This can help prevent palpitations and help you better manage them when they occur.
• Try deep relaxation or breathing exercises.
• Practice yoga, meditation, or tai chi.
• Get regular exercise.
• Do not smoke.

Once a serious cause has been ruled out by your health care provider, try not to pay close attention to heart palpitations. This may cause stress. However, contact your provider if you notice a sudden increase or a change in them.

If you have never had heart palpitations before, see your provider.

Call 911 or the local emergency number if you have:

• Loss of alertness (consciousness)
• Chest pain
• Shortness of breath
• Unusual sweating
• Dizziness or lightheadedness

Contact your provider right away if:

• You often feel extra heartbeats (more than 6 per minute or coming in groups of 3 or more).
• You have heart disease or risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
• You have new or different heart palpitations.
• Your pulse is more than 100 beats per minute (without exercise, anxiety, or fever).
• You have related symptoms, such as chest pain, shortness of breath, feeling faint, or loss of consciousness.
  

Your provider will examine you and ask questions about your medical history and symptoms.

You may be asked:

• Do you feel skipped or stopped beats?
• Does your heart rate feel slow or fast when you have the palpitations?
• Do you feel a racing, pounding, or fluttering?
• Is there a regular or irregular pattern to the unusual heartbeat sensations?
• Did the palpitations begin or end suddenly?
• When do the palpitations occur? In response to reminders of a traumatic event? When you are lying down and resting? When you change your body position? When you feel emotional?
• Do you have any other symptoms?
• Do you consume stimulant drugs (such as amphetamine or cocaine), caffeine or excessive alcohol?

An electrocardiogram may be done.

If you go to an emergency room, you will be connected to a heart monitor. However, most people with palpitations do not need to go to an emergency room for diagnosis and treatment.

If your provider finds you have an abnormal heart rhythm, other tests may be done. This may include:

• Holter monitor for 24 hours, or another heart monitor for 2 weeks or longer
• Echocardiogram
• Electrophysiology study (EPS)
• Coronary angiography

Heartbeat sensations; Irregular heartbeat; Palpitations; Heart pounding or racing

Curtis AB, Tomaselli GF. Approach to the patient with cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 61.

Fang JC, O'Gara PT. History and physical examination: an evidence-based approach. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Olgin JE. Approach to the patient with suspected arrhythmia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 49.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.