Heart Palpitations: Causes, Ectopic Beats and When to Worry

Heart palpitations are when you suddenly notice your heartbeat: it may feel strong, fast, fluttering or as if it skips a beat. Most are harmless and come from caffeine, stress, alcohol, poor sleep or extra beats. See a doctor if they keep coming back, last for minutes, or come with chest pain, breathlessness or dizziness. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What are heart palpitations?

They are the feeling of your own heartbeat. Most of the time we do not notice it. When we do, it can feel like pounding, fluttering, racing, an extra beat, or a pause and then a hard thump. Some people feel it in the neck or throat.

Feeling your heart does not mean something is wrong with it. Often the rhythm is normal and you are simply more aware of it, for example at night, lying on your left side, or in a quiet room.

In Spain doctors write palpitaciones. A skipped beat is an extrasístole, and AF is fibrilación auricular.

What causes palpitations?

Most have an everyday trigger. The NHS lists these as the most common:

• Coffee, tea, energy drinks and fizzy drinks with caffeine.
• Alcohol, nicotine and drugs such as cocaine or amphetamines.
• Stress, anxiety or a panic attack.
• Hard exercise, fever, not drinking enough, or poor sleep.
• Pregnancy and the menopause.
• Some medicines, such as nasal decongestants, asthma inhalers or thyroid tablets.

Other health problems can also cause them: low iron (anaemia), an overactive thyroid, low blood sugar, low potassium or a heart rhythm problem. That is why a doctor asks about your symptoms and may order a blood test.

What are ectopic beats?

They are beats that come a little too early. A short pause follows, and the next beat is stronger. So you feel a thump, a jump or a missed beat.

They are very common, even in healthy people, and are usually harmless. Coffee, alcohol, tiredness and stress make them more likely. If they are very frequent, happen during exercise, or you have heart disease, a doctor may do an ECG or a Holter test. A Holter records your heart rhythm for one or more days.

Could it be atrial fibrillation?

Sometimes. AF is the most common heart rhythm problem. The pulse is fast and has no pattern at all. It is more common after 65, and in people with high blood pressure, diabetes, obesity, sleep apnoea or heart disease.

It matters because it raises the risk of stroke. It is only confirmed by an ECG taken while it is happening. If you have it, a doctor looks at how to control the rhythm and whether you need a medicine to prevent clots.

Another rhythm problem, supraventricular tachycardia (SVT), starts and stops suddenly. The pulse is very fast but regular. It is more common in younger people.

Can anxiety cause palpitations?

Yes, often. Anxiety speeds up the heart and makes you notice it more. But do not assume it is anxiety without ruling out other causes, above all the first time, or if you feel dizzy, or if heart problems run in your family. Read more about anxiety and how it is treated.

How do I check my pulse during palpitations?

Place two fingers on your wrist, below the thumb. Count the beats for 30 seconds and double it. Notice whether the rhythm is regular or not. If you can, write down the time, what you were doing and how long it lasted. Some smartwatches can record a rhythm strip to show a doctor. To know what number is normal, see our guide to normal resting heart rate.

What tests might I need?

• A check of your pulse and blood pressure.
• An ECG, the basic test of heart rhythm.
• A Holter or event monitor if palpitations come and go.
• Blood tests: a full blood count to look for anaemia, thyroid and salts.
• Sometimes a heart scan (echocardiogram) or an exercise test.

What can I do at home?

• Cut down on coffee, energy drinks and alcohol.
• Stop smoking.
• Get enough sleep and drink water.
• Try slow breathing if you feel anxious.
• Ask your doctor or pharmacist to check your medicines. Do not stop any on your own.

When to see a doctor

• Palpitations keep coming back or happen more often.
• They last longer than a few minutes.
• Your pulse is irregular for no clear reason.
• You have heart disease, high blood pressure or diabetes.
• A young family member died suddenly from a heart problem.
• They come on during exercise.

When to call 112

Call 112 if palpitations come with:

• Chest pain or tightness.
• Shortness of breath.
• Fainting, or feeling you are about to faint.
• Palpitations that will not stop.

Do not drive yourself to hospital. See also our guide to chest pain and when to call 112.

Frequently asked questions about heart palpitations

Getting a medical assessment

If you are in Spain and worried about palpitations, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about our urgent, non-emergency video care and feeling dizzy when you stand up. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.