A palpitation is the sensation of feeling your own heartbeat in an unusual or uncomfortable way. It can show up as a rapid fluttering, a heavy pounding, a flip-flopping feeling, or the sensation that your heart skipped a beat. Most people feel palpitations in their chest, but they can also register in the throat or neck. Palpitations are extremely common, accounting for roughly 16% of all complaints that bring people to a primary care office.
What a Palpitation Actually Feels Like
The word covers a range of sensations, and people describe them differently. You might notice your heart beating too fast, pounding hard enough to feel it in your chest without touching it, or doing a brief “flip-flop” that catches your attention. Some people experience a sudden pause followed by a single strong thump. Others feel a sustained rapid flutter lasting seconds or minutes.
What’s actually happening inside the heart varies. In many cases, it’s a change in heart rate, rhythm, or the force of contraction. One of the most common culprits is an extra heartbeat (sometimes called a premature beat) that fires slightly early. The beat after that extra one is often stronger than normal because the heart had a slightly longer pause to fill with blood. That stronger-than-usual contraction is what you feel, sometimes even more than the extra beat itself. It’s the abnormal movement of the heart within the chest that creates the sensation.
Common Triggers
Many palpitations are triggered by everyday substances and situations rather than a heart problem. Caffeine and alcohol are two of the most frequently cited triggers, with evidence linking both to changes in heart rhythm and extra beats. Nicotine, whether from cigarettes or vaping, stimulates the nervous system in ways that speed up heart rate and can provoke irregular rhythms.
Stress, anxiety, and poor sleep are also reliable triggers. When you’re stressed, your body releases hormones that rev up your heart rate and make you more aware of your heartbeat. Intense exercise, dehydration, and even a large meal can produce the same effect. For some people, the palpitation itself triggers anxiety, which then keeps the heart racing in a cycle that feels harder to break than it actually is.
Medications That Can Cause Palpitations
Several common medications can trigger palpitations as a side effect. Asthma inhalers that open the airways work by stimulating the same receptors that speed up the heart, and some people notice a racing or fluttery feeling after using them. Over-the-counter decongestants found in cold and sinus medications can do the same thing by activating your body’s “fight or flight” response.
Stimulant medications, including those prescribed for ADHD, sometimes cause palpitations. Illicit stimulants like cocaine and methamphetamine carry a much higher risk and can trigger dangerous rhythm disturbances. If you notice new palpitations after starting or changing a medication, that’s worth mentioning at your next appointment.
Medical Conditions Behind Palpitations
Not all palpitations come from lifestyle factors. An overactive thyroid gland floods the body with hormones that speed up metabolism and heart rate, often producing persistent palpitations along with weight loss, tremor, and heat intolerance. Anemia, where the blood carries less oxygen than normal, forces the heart to beat faster and harder to compensate, and you may feel every one of those extra beats.
Low levels of certain minerals in the blood, particularly potassium and magnesium, can destabilize the heart’s electrical system and trigger irregular rhythms. Fever, dehydration, and hormonal shifts during pregnancy or menopause are other non-cardiac causes that commonly produce palpitations. In a smaller number of cases, palpitations signal an actual heart rhythm disorder like atrial fibrillation, where the upper chambers of the heart quiver chaotically instead of beating in a coordinated way.
When Palpitations Are a Red Flag
Most palpitations are harmless. A brief flutter that lasts a few seconds and resolves on its own, especially if you can link it to caffeine, stress, or poor sleep, is rarely dangerous. The picture changes when palpitations come with other symptoms.
Chest pain, sudden dizziness or lightheadedness, and fainting or near-fainting alongside palpitations all warrant immediate emergency care. A heart that suddenly races for no clear reason and stays fast for minutes, especially if you feel faint or short of breath during the episode, is another situation that needs urgent evaluation. These combinations can signal a rhythm disturbance that affects the heart’s ability to pump blood effectively.
How Palpitations Are Diagnosed
The challenge with diagnosing palpitations is that they often come and go. A standard electrocardiogram (ECG) records the heart’s electrical activity, but only captures a snapshot of a few seconds. If your heart happens to be in a normal rhythm during the test, it won’t show anything abnormal.
For palpitations that happen frequently, a Holter monitor is a portable device you wear for a day or more that continuously records your heart rhythm during normal activities. If your palpitations are less predictable, an event recorder may be a better fit. You wear it for up to 30 days and press a button when you feel symptoms, so the device captures the heart’s electrical pattern at that exact moment. Matching your symptoms to a rhythm recording is the key step that tells your doctor whether the palpitations reflect something that needs treatment or something you can safely manage on your own.
Stopping Palpitations in the Moment
For certain types of fast heart rhythms, simple physical techniques called vagal maneuvers can slow the heart by activating the body’s “rest and digest” nervous system. The most accessible one is the Valsalva maneuver: take a deep breath and bear down as if you’re straining, holding that effort for 10 to 15 seconds. A practical variation is blowing hard into a syringe or an obstructed straw until you feel the resistance. A modified version where you immediately lie flat and raise your legs after bearing down has been shown to restore a normal rhythm in over 40% of cases, more than double the success rate of the standard technique.
Another approach is the diving reflex, triggered by splashing ice-cold water on your face or briefly submerging your face in cold water. This mimics the body’s response to diving into cold water and can abruptly slow a racing heart. These maneuvers work best for a specific type of rapid rhythm originating in the upper chambers of the heart. They won’t help with the occasional skipped-beat sensation, but that type usually resolves on its own within seconds.
Reducing Palpitations Over Time
If your palpitations are tied to lifestyle triggers, the fix is often straightforward. Cutting back on caffeine, reducing alcohol intake, and managing stress through exercise or breathing techniques can meaningfully reduce how often palpitations occur. Staying well hydrated and getting consistent sleep also help stabilize heart rhythm.
When an underlying condition like thyroid disease or anemia is driving the palpitations, treating that condition typically resolves them. For people with a diagnosed heart rhythm disorder, treatment ranges from daily medication to procedures that correct the faulty electrical pathways in the heart, depending on the specific rhythm involved and how much it affects daily life.