Most heart palpitations are harmless and stop on their own within seconds to minutes. When you feel your heart racing, fluttering, or skipping beats, the first step is to stay calm, stop what you’re doing, and try a simple breathing technique to reset your heart’s rhythm. If the palpitations come with chest pain, fainting, or serious shortness of breath, that changes the picture entirely and you need emergency care.
Try Vagal Maneuvers to Reset Your Rhythm
Your vagus nerve runs from your brain to your abdomen and helps regulate your heart rate. Stimulating it can slow a racing heart quickly. These techniques, called vagal maneuvers, are the first thing to try when palpitations start.
The most effective option is the Valsalva maneuver. Lie on your back, take a deep breath, then bear down as if you’re trying to exhale through a blocked straw, keeping your nose and mouth closed. Hold this for 10 to 30 seconds. You’re essentially creating pressure in your chest that activates the vagus nerve and tells your heart to slow down.
If that doesn’t appeal to you, try the diving reflex instead. While sitting, take several deep breaths, hold the last one, and quickly submerge your entire face in a bowl of ice water. Keep your face in the water as long as you can manage. If you don’t have a bowl handy, pressing a bag of ice or a cold, wet towel firmly against your face produces a similar effect. You can also try forceful coughing, which creates the same kind of chest pressure as the Valsalva maneuver.
Know When Palpitations Need Emergency Care
Palpitations alone are rarely dangerous. But certain combinations of symptoms signal something more serious. Go to the emergency department if you experience any of the following alongside palpitations:
- Sudden collapse or loss of consciousness. This suggests your heart may not be pumping blood effectively.
- Chest pain or pressure. This could indicate a heart attack or another cardiac event.
- Significant dizziness or lightheadedness. A racing heart paired with feeling faint means your brain may not be getting enough blood flow.
- Serious trouble breathing or confusion. These are signs your body isn’t getting enough oxygen.
If your palpitations are brief, happen occasionally, and resolve on their own without any of these warning signs, you’re likely dealing with something benign. Still, frequent episodes are worth bringing up with your doctor even if they don’t feel dangerous.
Identify and Reduce Your Triggers
Many palpitations have a clear trigger, and finding yours is one of the most useful things you can do. Caffeine, alcohol, and nicotine are the three most common culprits. You don’t necessarily need to eliminate coffee entirely, but paying attention to whether your palpitations follow your second or third cup can be revealing. Alcohol, even in moderate amounts, can provoke irregular rhythms in some people.
Dehydration is another overlooked trigger. When your body is low on fluids, your blood volume drops. Your heart compensates by beating faster and harder to circulate the smaller amount of blood. This can feel like pounding or racing, especially during physical activity or in hot weather. Drinking enough water throughout the day is one of the simplest fixes available.
Poor sleep, high stress, and intense exercise can also set off episodes. Keeping a brief log of when your palpitations happen, what you consumed beforehand, and how you were feeling can help you spot patterns. That same log becomes valuable information if you eventually see a doctor about them.
Anxiety and Palpitations Often Overlap
Anxiety is one of the most common causes of palpitations, and it creates an unpleasant feedback loop: you feel your heart racing, which makes you more anxious, which makes your heart race more. Anxiety-related palpitations tend to start suddenly, feel intense, and then resolve within a few minutes. They often come with other anxiety symptoms like sweating, a sense of dread, or tingling in your hands.
Palpitations caused by a heart condition tend to behave differently. They may last longer, happen without an obvious emotional trigger, or recur in predictable patterns. They’re also more likely to come with physical symptoms like chest pain, breathlessness, or fainting.
That said, the overlap can be confusing. Having anxiety doesn’t rule out a cardiac cause, and having a heart condition doesn’t mean anxiety isn’t amplifying your symptoms. If you’re unsure which camp you fall into, testing can clarify things.
What Happens at the Doctor’s Office
If your palpitations are frequent, last more than a few minutes, or concern you enough to seek evaluation, your doctor will likely start with an electrocardiogram (EKG). This painless test takes just a few minutes: electrodes are placed on your chest to record your heart’s electrical activity. It can reveal whether your heart is beating too fast, too slow, or in an irregular pattern.
The tricky part is that palpitations often don’t happen on command. If your EKG looks normal but you’re still having episodes, you may be asked to wear a Holter monitor, a small portable device that records your heart rhythm continuously for 24 to 48 hours while you go about your normal life. If your episodes are less frequent than once a week, an event recorder is a better fit. You wear it for up to 30 days and press a button whenever you feel symptoms, capturing the rhythm in real time.
Depending on what your doctor suspects, they may also order blood work to check for anemia or low potassium, both of which can cause palpitations. An echocardiogram, which uses ultrasound to create a moving picture of your heart, can identify structural problems like valve issues. And if thyroid disease is a possibility, a simple blood test can check that too.
Thyroid Problems Are a Hidden Cause
Your thyroid gland controls the speed of many body processes, including your heart rate. An overactive thyroid pumps out excess thyroid hormone, which makes the heart beat harder and faster. It can even trigger atrial fibrillation, a disorganized rhythm in the upper chambers of the heart that feels like fluttering or quivering in the chest.
Other signs that your thyroid might be involved include unexplained weight loss, feeling hot all the time, trembling hands, or difficulty sleeping. If palpitations are your main complaint and your doctor can’t find a heart-related explanation, thyroid testing is a logical next step. Treating the thyroid problem typically resolves the palpitations.
How Palpitations Are Treated Long-Term
Treatment depends entirely on the cause. If your palpitations are triggered by caffeine, stress, or dehydration, lifestyle changes may be all you need. Cutting back on stimulants, managing anxiety through breathing exercises or therapy, staying hydrated, and getting consistent sleep can dramatically reduce how often episodes occur.
When palpitations are frequent enough to disrupt your daily life, or when they’re caused by an underlying rhythm problem, medication may help. Beta-blockers are the most commonly prescribed option. They work by blocking the stress hormones that tell your heart to speed up, which prevents it from beating too fast. Most people tolerate them well, though they can cause fatigue or cold hands in some cases.
For palpitations driven by anxiety, treating the anxiety itself is often the most effective path. Cognitive behavioral therapy, regular exercise, and sometimes anti-anxiety medication can break the cycle of panic and palpitations feeding into each other. Addressing the root cause tends to work better than simply managing the heart symptoms in isolation.