Palpitations describe awareness of the heartbeat. The sensation may reflect a normal rhythm, premature beats or a sustained arrhythmia; the feeling alone does not identify the mechanism.
Why the Symptom Pattern Matters
- A sudden regular rapid rhythm may suggest a re-entry tachycardia.
- An irregularly irregular rhythm may occur with atrial fibrillation, but pulse sensation is not diagnostic.
- Isolated thumps or pauses often reflect premature beats.
- Episodes during exertion, with fainting or in structural heart disease require greater caution.
Possible Causes
This list explains possibilities; the symptom alone cannot establish a diagnosis.
- Sinus tachycardia from exercise, fever, pain or anxiety
- Premature atrial or ventricular beats
- Supraventricular tachycardia, flutter or atrial fibrillation
- Ventricular arrhythmia
- Anaemia, thyroid disease or electrolyte disturbance
- Caffeine, alcohol, stimulants and some medicines
What the Clinician Will Assess
- Sudden or gradual onset and end
- Regularity, duration and recorded heart rate
- Fainting, chest pain, breathlessness or family sudden death
- Medicine, supplement, alcohol and stimulant exposure
Which Tests May Be Considered?
Not every test is required for every person. Selection depends on examination findings and clinical probability.
- 12-lead ECG during symptoms when possible
- Holter, patch or event monitor matched to episode frequency
- Blood count, thyroid and electrolytes when indicated
- Echocardiography if structural disease is suspected
What to Record Before the Appointment
- Start and stop time
- Pulse rate and regularity
- Activity, sleep, alcohol, caffeine and medicines
- Wearable ECG saved in original form when available
When to Call Emergency Services
- Palpitations with fainting or near-collapse
- Severe chest pain or breathlessness
- Persistent very rapid rhythm with weakness or low blood pressure
- New neurological symptoms
Frequently Asked Questions
Does every palpitation mean arrhythmia?
No. Normal rhythm can feel forceful, and rhythm recording is needed for diagnosis.
Can a smartwatch diagnose the cause?
It may provide a useful trace, but recording quality and algorithms have limitations and need professional interpretation.
Should I take an extra heart tablet?
Not unless your clinician has given a specific episode plan.
This page provides general information and does not replace examination, diagnosis or an individual treatment plan.