Heart palpitations and ectopic beats

Heart palpitations are heartbeats that suddenly become more noticeable.

Your heart may feel like it's pounding, fluttering or beating irregularly, often for just a few seconds or minutes. You may also feel these sensations in your throat or neck.

Palpitations may seem alarming, but in most cases they're harmless and aren't a sign of a serious problem.

Sometimes you may feel an extra or missed beat. These are known as ectopic beats and are also usually nothing to worry about.

Causes of heart palpitations

Causes of heart palpitations include:

• lifestyle triggers
• emotions and psychological triggers
• medication
• hormone changes
• heart rhythm problems
• heart conditions
• other medical conditions

Click on these links for more information about these causes.

Lifestyle triggers

Common triggers of heart palpitations include:

• strenuous exercise
• not getting enough sleep
• drinks containing caffeine, such as coffee, tea and energy drinks
• alcohol
• smoking
• illegal drugs, such as cocaine, heroin, amphetamines, ecstasy and cannabis
• rich or spicy foods

In these cases, the palpitations should go away on their own. Avoiding these triggers may help stop them coming back.

Emotional or psychological triggers

Heart palpitations are also often caused by emotions or psychological issues, such as:

• excitement or nervousness 
• stress or anxiety
• panic attacks – an overwhelming sense of anxiety or fear, accompanied by feeling sick, sweating, trembling and palpitations

Breathing exercises and panic attack tips may help if you're feeling stressed, anxious or panicky.

Medication

Palpitations can occasionally be triggered by some types of:

• asthma inhalers, such as salbutamol and ipratropium bromide
• high blood pressure (hypertension) medicines, such as hydralazine and minoxidil
• antihistamines, such as terfenadine
• antibiotics, such as clarithromycin and erythromycin
• antidepressants, such as citalopram and escitalopram
• antifungal medicines, such as itraconazole

Speak to your GP if you think medication may be causing your palpitations. But don't stop taking a prescribed treatment without first getting medical advice.

Hormone changes

Heart palpitations in women can sometimes be the result of hormonal changes that occur during:

• periods
• pregnancy
• the menopause – when a woman stops having periods and is no longer able to get pregnant naturally

In these cases, the palpitations are usually temporary and not a cause for concern.

Heart rhythm problems

Palpitations are sometimes caused by a problem with the heart rhythm, such as:

• atrial fibrillation – a heart rhythm problem that can cause a fast, irregular heart rate
• atrial flutter – a rhythm disturbance that can be fast and either regular or irregular
• supraventricular tachycardia (SVT) – a heart rhythm problem that causes episodes of an abnormally fast but regular heart rate; it's common in young, otherwise healthy, people
• ventricular tachycardia – a more serious and typically fast, regular heart rhythm disturbance that can be associated with dizziness or blackouts

These conditions are known as arrhythmias.

Heart conditions

Some palpitations may be associated with other problems with the heart, such as:

• a problem with the heart valves, such as mitral valve prolapse
• hypertrophic cardiomyopathy – where the heart muscle and walls of the heart become enlarged and thickened
• heart failure – where the heart is unable to pump blood around the body properly
• congenital heart disease – birth defects that affect the normal workings of the heart

Some of these conditions can be serious and often require treatment.

Other medical conditions

The following conditions can also sometimes cause heart palpitations:

• an overactive thyroid (hyperthyroidism) – where the thyroid gland produces too much of the thyroid hormones
• a low blood sugar level (hypoglycaemia) – this is most commonly associated with diabetes
• anaemia – a reduced number of red blood cells
• postural or orthostatic hypotension – dizziness and low blood pressure triggered by changing position (such as standing up)
• a high temperature (fever) of 38C (100.4F) or above 
• dehydration

When to see your GP

You don't usually need to see your GP if the palpitations pass quickly and occur only occasionally. They're unlikely to be caused by a serious problem and probably won't need treatment.

But it's a good idea to contact your GP if:

• the palpitations last a long time, don't improve or get worse
• you have a history of heart problems
• you're concerned about the palpitations

To help determine the cause, your GP may:

• ask about your symptoms and medical history
• arrange some blood tests
• carry out an electrocardiogram (ECG) to check your heart rate (if your GP has the equipment available)

If you can't have an ECG at your GP surgery or your doctor wants to arrange heart monitoring over a longer time period, you may be referred for tests at a local hospital.

When to get emergency help

Call 999 for an ambulance or visit your nearest accident and emergency (A&E) department if you have heart palpitations and any of the following symptoms:

• severe shortness of breath
• chest pain or tightness
• dizziness or light-headedness
• fainting or blackouts

These symptoms could indicate a serious or potentially life-threatening heart problem that should be checked by a doctor as soon as possible.