Palpitations are heartbeats you suddenly become aware of. Your heart may feel like it is pounding, fluttering, racing or skipping a beat. They are very common and often harmless, but if they keep coming back, a resting ECG, a Holter monitor or an echocardiogram can help find out what is going on.
What do palpitations feel like?
People describe palpitations in different ways. You might notice:
- a pounding or thumping in your chest, throat or neck
- a fluttering or "butterflies" feeling
- a racing heartbeat, even when you are resting
- a missed or extra beat, sometimes followed by a stronger thud
- a heartbeat that feels irregular or out of rhythm
Palpitations can last a few seconds or a few minutes, and occasionally longer. They may happen once, now and then, or several times a day. Some people notice them more when lying down at night.
What causes palpitations?
In most people, palpitations are not caused by a serious heart problem. Common everyday triggers include:
- stress, anxiety or panic
- caffeine, alcohol and nicotine
- strenuous exercise
- lack of sleep
- some medicines (check the leaflet that came with yours)
- recreational drugs
- hormone changes, such as during pregnancy or the menopause
Sometimes palpitations are linked to a health condition. These can include iron deficiency anaemia, an overactive thyroid, heart valve disease, or a heart rhythm problem (arrhythmia) such as atrial fibrillation. This is why it is sensible to get checked if your palpitations keep happening.
A simple diary can help. Note when palpitations happen, how long they last, what you were doing, and whether you had coffee, alcohol or a poor night's sleep. This gives your clinician useful clues.
When are palpitations an emergency?
Call 999 or go to A&E straight away if you have palpitations and:
- chest pain or tightness
- shortness of breath or severe breathlessness
- dizziness or light-headedness
- you feel faint, or you have fainted or collapsed
- the palpitations do not go away
Do not drive yourself to A&E. If any of these symptoms happened but have now stopped, ask your GP for an urgent appointment or contact NHS 111.
You should also speak to your GP if your palpitations keep coming back, are becoming more frequent, last more than a few minutes, or if you have a heart condition or a family history of heart problems. The NHS guide to heart palpitations has more advice.
A private heart test is not a substitute for emergency care. If you are worried right now, get urgent help first.
Which heart test do I need for palpitations?
There are three main tests used to look into palpitations. Each one answers a different question, and your clinician may suggest one or more of them.
| Test | What it checks | Best for |
|---|---|---|
| Resting 12-lead ECG | Your heart's electrical activity for a few seconds | A quick first check, or symptoms happening during the test |
| Holter monitor | Every heartbeat over 24 hours to 14 days | Palpitations that come and go |
| Echocardiogram | The structure and pumping of your heart, and its valves | Checking the heart itself is healthy |
Resting ECG: a quick first look
An electrocardiogram (ECG) records your heart's electrical signals using small sticky pads on your chest, arms and legs. The recording itself takes only a few minutes and is painless.
An ECG can show your heart rate and rhythm and may pick up signs of a rhythm problem or strain on the heart. Its main limit is timing. It only records for a short while, so if your palpitations are not happening during the test, it may look normal.
Holter monitor: catching symptoms that come and go
A Holter monitor is a small, lightweight recorder that you wear while going about your normal day. It records every heartbeat, so it can catch palpitations that a short ECG might miss. You press a button or note the time when you feel symptoms, which lets your heartbeat be matched to how you felt.
A standard Holter usually records for 24 to 48 hours, sometimes longer. Because a short recording can miss symptoms that do not happen often, the right length depends on how often your symptoms happen. As a general guide:
- Daily palpitations: 24 or 48 hours may be enough.
- Every few days: 72 hours or 7 days may give a better chance of a recording.
- Less often: 14 days may be more useful. For very infrequent symptoms, a specialist may suggest other types of longer-term monitor.
Your clinician will advise on the best option for you. Our complete guide to Holter monitoring explains more.
The self-fit Holter kit
If it is easier, a self-fit Holter kit can be posted to you with clear instructions. You attach the monitor yourself at home, wear it for the agreed time, then send it back for analysis. This can suit you if you are busy, live further away, or prefer not to travel.
Echocardiogram: checking the heart's structure
An echocardiogram is an ultrasound scan of your heart. It shows how well your heart pumps, the size of its chambers, and how your valves are working. It does not record rhythm over time, but it helps check whether a structural problem, such as valve disease or a weakened heart muscle, could be behind your palpitations.
An echo is not needed for everyone with palpitations. It is usually suggested if a rhythm problem has been found, or if a structural heart problem is suspected, and it is used alongside an ECG or Holter rather than instead of one. In simple terms, an ECG looks at the heart's wiring, while an echocardiogram looks at its structure and pumping.
What happens after the test?
Your recording or scan is reviewed and you receive a written report. If everything looks normal, that is often very reassuring, and simple changes such as cutting down on caffeine or improving sleep may be all you need.
If something needs attention, your report will explain the findings, and you may be advised to see your GP or a cardiologist for further tests or treatment. Keep a copy to share with your GP.
Can I reduce palpitations myself?
If no worrying cause is found, these steps may help:
- cut back on caffeine, energy drinks and alcohol
- stop smoking
- try to get regular, good-quality sleep
- find ways to manage stress, such as breathing exercises, walking or yoga
- keep active with regular, moderate exercise
Do not stop any prescribed medicine without speaking to your doctor first.
Frequently asked questions
Are palpitations dangerous?
Most palpitations are harmless and linked to things like stress, caffeine or poor sleep. However, if they come with chest pain, breathlessness or fainting, call 999.
Can anxiety cause palpitations?
Yes. Anxiety and stress are among the most common causes. It is still worth getting checked if they keep happening, so other causes can be ruled out.
Will a normal ECG rule out a heart rhythm problem?
Not always. A resting ECG only records for a short time, so a rhythm problem that comes and goes can be missed. A Holter monitor records for much longer.
Which Holter length should I choose?
It depends on how often your symptoms happen. Daily symptoms are often picked up in 24 to 48 hours, while less frequent ones may need 7 or 14 days. Your clinician will advise.
Do I need a GP referral for a palpitations test?
No. You can book yourself. Referrals from GPs and specialists are also welcome.
Booking a heart test with The Heart Clinic
You can book a resting ECG, Holter monitor or echocardiogram without a GP referral, at our Luton clinic or at home across London, Hertfordshire and Buckinghamshire. Prices include the test, clinical review and written report, which is usually ready within 24 working hours. See our prices or get in touch to book.