Symptoms — Heart Rhythm
Palpitations — Racing Heart
Palpitations are an awareness of your own heartbeat — a sensation most people experience occasionally. When they are frequent, prolonged, or accompanied by other symptoms, investigation is essential to rule out an underlying arrhythmia.
Understanding the Symptom
What Are Palpitations?
Palpitations refer to an awareness of your own heartbeat. This is something everyone experiences occasionally — particularly after strenuous exercise, during an exciting moment, or following a large dose of caffeine. This is completely normal.
However, palpitations can also indicate cardiac arrhythmias — disruptions in the heart's electrical signals that affect its normal rhythm. When palpitations are frequent, prolonged, occur at rest, or are associated with dizziness, chest tightness, or breathlessness, they require investigation.
Understanding the character of the palpitations — how they start, how long they last, what brings them on, and how they stop — provides crucial diagnostic information before any testing begins.
How Patients Describe Them
How Palpitations Feel
Palpitations manifest in many different ways. The type of sensation can help identify the underlying rhythm disturbance.
A pounding sensation in my chest
Often sinus tachycardia or anxiety
A fluttering or quivering feeling
May suggest atrial fibrillation
My heart skips a beat then thuds heavily
Classic description of ectopic beats
A sudden racing that stops as abruptly as it starts
Suggests SVT or paroxysmal AF
An irregular, chaotic rhythm I cannot predict
Often atrial fibrillation
My heart races and I feel dizzy or faint
Warrants urgent investigation
What Triggers Them
Causes of Palpitations
Lifestyle Triggers
Lifestyle Factors
- Caffeine — coffee, tea, green tea, matcha, energy drinks
- Alcohol — even moderate amounts can trigger AF episodes
- Stress & Anxiety — adrenaline directly accelerates heart rate
- Smoking — nicotine stimulates adrenal release
- Recreational Drugs — cocaine and stimulants trigger SVT and VT
- Dehydration — electrolyte imbalance destabilises heart rhythm
Medical Conditions
Cardiac & Medical
- Atrial Fibrillation — irregular, chaotic upper chamber activity
- Ectopic Beats — premature extra heartbeats from the atria or ventricles
- SVT — supraventricular tachycardia causing sudden rapid heartbeat
- Heart Failure — impaired pumping triggers compensatory tachycardia
- Coronary Artery Disease
- Thyroid Disease — thyroxine is a direct cardiac stimulant
Hormonal Factors
Hormonal Changes
- Menstrual Cycle — hormonal fluctuations affect autonomic tone
- Pregnancy — blood volume and heart rate naturally increase
- Menopause — hot flushes trigger adrenal surges and palpitations
- HRT — hormone replacement therapy can alter rhythm threshold
- Medications — salbutamol inhalers and decongestants raise heart rate
- Anaemia — compensatory tachycardia to maintain oxygen delivery
Helping Dr Nijjer Diagnose You
Key Questions to Consider
Providing detailed answers to these questions at your consultation helps Dr Nijjer identify the likely arrhythmia before testing even begins. If possible, keep a brief symptom diary.
Do the symptoms start gradually or suddenly — and stop gradually or abruptly?
What triggers them? Exercise, stress, caffeine, alcohol, time of day?
How long do episodes last — seconds, minutes, or hours?
Is the rhythm fast and regular, fast and irregular, or just occasional extra beats?
Are they accompanied by chest tightness, breathlessness, or dizziness?
Have you ever fainted or nearly fainted during an episode?
Investigation
Tests for Palpitations
All patients with palpitations should have an ECG and, in most cases, an echocardiogram. Capturing the rhythm during symptoms is the definitive diagnostic step.
- ECGA 12-lead ECG detects arrhythmias present at the time of recording and identifies structural abnormalities such as pre-excitation (WPW) that predispose to tachycardias.
- EchocardiogramUltrasound of the heart to assess structure and pumping function. Structural abnormalities can cause or contribute to arrhythmias.
- Ambulatory ECGA recording device worn for 24–48 hours or longer captures rhythm during daily activities and correlates symptoms with any arrhythmia present.
- Blood TestsElectrolytes (potassium, magnesium, calcium), thyroid function, and a full blood count to exclude anaemia and metabolic causes.
- Exercise TestWhere symptoms occur during exercise, an exercise stress test can provoke and record the responsible arrhythmia.
Related Conditions
Further Reading
Experiencing palpitations?
Dr Nijjer offers expert assessment of palpitations and arrhythmias at 68 Harley Street, with ambulatory ECG monitoring, echocardiography, and tailored treatment plans available promptly.