Heart palpitations can be temporary sensations. Your heart may be beating faster or harder or skipping a beat out of its normal rhythm.

While they can come from exercise or stress, heart palpitations can also signal heart trouble. They should be taken seriously if you have heart disease, are at high risk for heart disease, or if the palpitations come with other symptoms or the symptoms are persistent and bothersome.

It’s important to know the many factors that can trigger heart palpitations. This can help you know when they aren’t a cause for concern or when they indicate a potentially serious health problem.

Heart palpitations are changes in your heartbeat that are significant enough for you to notice them. Palpitations are signs that your heart rate has increased or changed in some way.

The sensation may be normal and predictable, like a racing heart following a good run.

But heart palpitations can also be unusual heartbeats due to a change in the heart’s electrical system. This can cause your heart to speed up with no obvious reason, “skip a beat,” or slow down. These abnormal rhythms are called arrhythmias and often require medical care.

Changes in your heart rate that result in palpitations are typically caused by factors that affect the intensity or rhythm of your heartbeat. Common causes include:

  • exercise and heavy physical exertion
  • use of caffeine, nicotine, alcohol, or narcotics
  • certain medications
  • stress, anxiety, or other mood disorders
  • hormone changes
  • arrhythmias and other heart conditions
  • electrolyte abnormalities

Heart palpitations can be described in different ways. The following terms describe the different types of sensations you may notice in your chest:

  • pounding
  • thudding
  • racing
  • fluttering
  • flip-flopping
  • murmuring
  • skipping

You may also feel palpitations radiating to your neck.

Heart palpitations may accompany other symptoms, such as general uneasiness. However, feelings of impending doom may also be symptoms of a heart attack.

Other symptoms that sometimes appear with heart palpitations include:

While heart palpitations in any setting may be concerning, they can be fleeting changes in your heart rate that are responses to various stimuli, rather than symptoms of an underlying health condition.

However, there are some situations when you should see a healthcare professional soon or get emergency medical attention.

Benign causes

Many types of heart palpitations are the result of common causes that can get better when the triggers are removed, such as:

  • Exercise. If you get your heart rate up while running, swimming, or doing some other aerobic activity, you can expect to feel your heart beating harder during and immediately after exercise. Palpitations should start to fade once you’ve stopped exercising.
  • Diet. Your diet may also bring on heart palpitations. A high-carb meal may trigger palpitations if you have low blood sugar. Likewise, an extra cup of coffee or a caffeine-packed energy drink may get your heart racing and your head buzzing a little. But as the caffeine wears off, so too should those side effects. Drinking alcohol may cause palpitations, too.
  • Stress. Events such as giving a public presentation, swerving to avoid an accident on the road, and other brief moments of stress may trigger heart palpitations, sweating, nausea, and other physical responses. These should be temporary sensations.

Moderate concern

Heart palpitations that occur in the following situations should be of concern but may not be a medical emergency. Because they could be signs of an underlying health condition, you should make an appointment to discuss them with a healthcare professional.

  • Anxiety. Excessive worry can activate the body’s autonomic nervous system (the so-called fight-or-flight response). If the following symptoms of anxiety begin to interfere with your usual functioning, tell your doctor or seek the help of a mental health professional:
    • heart palpitations
    • rapid breathing
    • tense muscles
    • nausea
  • Pregnancy. Your body goes through many changes throughout pregnancy. Among them are increases in your heart rate and in the amount of blood circulating throughout your body. The result can be heart palpitations that may come on suddenly or with exercise. You can also have palpitations as a result of pregnancy hormones. They are usually brief episodes but may occasionally be signs of something more serious. If they persist, tell your doctor promptly.
  • At night. Heart palpitations at night may be brought on by changes in your breathing while you are sleeping. If they happen recurrently, they could signal an arrhythmia or other condition that should be evaluated.

Serious concerns

The three main signs that your heart palpitations may be an early sign of a health problem include:

  • when they linger long after they should have subsided
  • when they come on frequently for no apparent reason, such as from exercise, stress, or caffeine consumption, as this may point to an arrhythmia
  • when they are accompanied by heart attack or arrhythmia symptoms, such as chest pain, nausea, shortness of breath, overwhelming anxiety, and unusual sweating

If you have symptoms of a heart attack, you should call 911 or go to a hospital emergency department.

However, if you’re unsure how to respond to heart palpitations, but that voice in your head is telling you that something is wrong, trust your instinct. It’s always better to err on the side of caution and get a proper medical evaluation than take your chances when you may be in the middle of a medical emergency.

Before you see a doctor about heart palpitations, think about how best to describe them (pounding, fluttering). You’ll likely be asked some or all of the following questions:

  • When did the palpitations start?
  • How long do they usually last?
  • How often are they occurring?
  • Does anything help ease them? Anything that makes them worse?
  • Do certain activities usually precede palpitations?
  • Do you have any other symptoms?

Before going into your appointment, think about the details of your medical history, family medical history, and make a list of all medications and supplements you take.

One of the main tests your doctor may recommend to better understand your heart palpitations is an electrocardiogram (ECG). Electrodes are placed on your chest to record the electrical signals that regulate your heartbeat. You may also have a stress test, as well as blood tests, to look for signs of thyroid disease, vitamin deficiencies, and markers for heart disease.

Research published in a 2018 journal article found that having an ECG as early as possible after palpitations begin can be critical in diagnosing arrhythmias before they become a serious condition.

Keep in mind that an ECG is just a “snapshot” of your heart at that time and may not reflect what your heart is doing during the arrhythmia or when you are having the palpitations.

Treatment for your heart palpitations will depend on their cause. Arrhythmias are sometimes treated with medications. In more serious cases, devices like a pacemaker may be implanted in your chest to regulate your heart rhythm.

Heart palpitations can affect anyone. They can be harmless changes in your heart rate due to exercise, stress, caffeine, or other factors.

However, heart palpitations can also be a sign of serious anxiety or underlying heart problem.

Knowing when to seek a medical evaluation for heart palpitations can help you get the diagnosis and treatment you need. Making other changes — such as cutting back on caffeine or learning stress management techniques — may also help calm your heart and give you peace of mind.