Palpitations

What are palpitations?

Palpitations are a feeling that your heart is beating in an unusual way. You might describe them as:

  • a racing heartbeat

  • pounding or throbbing in the chest, neck, or throat

  • fluttering

  • skipped or extra beats

They may occur at rest, on exertion, or at any time of day or night. Duration can vary from just a few seconds to longer spells. Most of the time they are harmless, but they can be distressing, and sometimes they indicate a more serious problem.

When to seek help

You should consider seeing a cardiologist if:

  • palpitations are frequent or worsening

  • they last for more than a few minutes at a time

  • you feel unwell during or after them (e.g. breathless, dizzy, feeling faint)

  • there is chest pain or tightness

  • you have existing heart disease, or there is heart disease in your family

  • they occur with other symptoms like sweating, fever, or swelling of the legs

If you ever experience palpitations alongside any of the following, please consider this an emergency and get medical attention immediately:

  • chest pain

  • sudden shortness of breath

  • fainting or loss of consciousness

  • feeling very light‑headed

Common causes

Palpitations have many possible causes. In many cases, a definite cause may not be found, and episodes are benign. Some of the more common triggers or underlying factors include:

Lifestyle factors and stimulants: Caffeine (coffee, tea, energy drinks), nicotine, alcohol, recreational drugs; certain over‐the‐counter or prescribed medications (e.g. stimulant drugs, some inhalers)

Emotional / psychological: Stress, anxiety, panic attacks; sudden fright or excitement

Physical exertion / lack of sleep: Exercise, fatigue, sleep deprivation.

Hormonal or metabolic changes: Pregnancy, menopause, thyroid disorders (hyperthyroidism), menstrual cycle, hormonal fluctuations

Other medical conditions: Anaemia; electrolyte imbalances; fever or infection; dehydration; low blood sugar; structural heart disease; arrhythmias

How we diagnose palpitations at London Heart Group

To understand your palpitations and their causes, our cardiologists follow a systematic approach:

  1. History & symptoms review
    We will ask detailed questions about what you feel, how often it occurs, how long it lasts, what seems to trigger it, whether you have other associated symptoms (chest pain, dizziness, fainting), any family history of heart disease, and what medications or substances you use.

  2. Physical examination
    Checking vital signs (pulse, blood pressure), listening to the heart and lungs, assessing other systems if needed.

  3. Baseline tests

    • Electrocardiogram (ECG) – to look at the electrical activity of the heart.

    • Blood tests – to check for things like thyroid function, electrolytes, anaemia, kidney function.

    • Chest X‑ray or other imaging if structural issues are suspected.

  4. Longer term monitoring
    If palpitations are intermittent and not captured on a resting ECG, we may ask you to wear a Holter monitor (24‑48 hours) or extended event recorder. Sometimes even longer monitoring (e.g. implantable loop recorders) if symptoms are infrequent but concerning.

  5. Imaging
    An echocardiogram (ultrasound of the heart) may be used to assess heart structure and function, to rule out structural heart disease.

  6. Special investigations
    If an arrhythmia is suspected (e.g. atrial fibrillation, supraventricular tachycardia), electrophysiological studies or other cardiology specialist tests may be recommended.

Treatment and management

Treatment depends on the cause, severity of symptoms, degree of impact on your life, and any underlying heart or health conditions. Options include:

Lifestyle / non‑medical measures

Often the first line of management:

  • Identifying and avoiding triggers (e.g. cutting down caffeine, alcohol, cigarettes, illicit stimulants)

  • Improving sleep hygiene; ensuring adequate rest

  • Reducing stress: relaxation techniques, mindfulness, breathing exercises, possibly counselling or therapies for anxiety or panic disorder

  • Staying hydrated; maintaining a balanced diet; managing other health problems (e.g. thyroid disease, anaemia)

Medications

If symptoms are frequent, severe, or there is an underlying cardiac condition, medications may be prescribed:

  • Rate control medications: e.g. beta‑blockers, calcium channel blockers, which slow the heart or moderate its response

  • Anti‑arrhythmic drugs: to try to correct the rhythm abnormality, depending on type of arrhythmia

  • Medications for associated conditions: treating thyroid disease, correcting anaemia, managing electrolyte disturbances, etc.

Procedures and more advanced therapies

In some cases, more interventional treatments are indicated:

  • Catheter ablation – for certain arrhythmias, tissue that is causing abnormal electrical signals can be destroyed to prevent further episodes

  • Pacemakers – if the heart rhythm becomes too slow or pauses

  • Implantable Cardioverter Defibrillators (ICD) – for life‑threatening arrhythmias (rare in the context of palpitations alone unless there is risk)

  • Cardioversion – a procedure sometimes used to restore a normal rhythm in atrial fibrillation

Frequently asked questions

Are palpitations dangerous?
Usually not. Most of the time they are benign. However, when they occur with other troubling symptoms (see above), or when tests reveal underlying heart disease or rhythm disorders, they may require more urgent treatment.

Will my palpitations always show up on an ECG?
Not necessarily. If palpitations are brief or occur infrequently, a resting ECG may be normal. That’s why ambulatory monitoring (Holter, event recorder) or longer‑term monitoring might be needed.

Can I carry on working and exercising?
In many cases, yes. Your doctor will advise based on how severe your symptoms are, what the triggers are, what your overall cardiac function is, and the type of arrhythmia (if any). Sometimes you may be advised to avoid strenuous exertion for a while or until investigations are completed.

Preventing palpitations

While not all palpitations can be prevented, many can be reduced or avoided by:

  • Keeping a healthy lifestyle: regular exercise, balanced diet, maintaining healthy weight

  • Avoiding or moderating intake of caffeine, alcohol, smoking or other stimulants

  • Getting adequate sleep and rest

  • Managing stress and anxiety proactively

  • Having regular medical check‑ups, especially if you have risk factors (thyroid disease, heart disease, family history, etc.)

How to arrange an appointment / what to bring

If you are experiencing palpitations and would like an assessment at London Heart Group, here is what helps:

  • Diary of symptoms: when they happen, how long they last, what you were doing, what you felt (chest‑pain, dizziness etc.), what seems to trigger and what seems to help

  • List of all medications, over‑the‑counter drugs, herbal supplements

  • Any existing test results (ECG, thyroid blood tests, etc.)

  • Be prepared to undergo ECG, blood tests, echocardiogram

What you can expect at London Heart Group

At London Heart Group, our approach is:

  • Expert specialist cardiologists who listen carefully and review your history and investigations thoroughly

  • Access to modern diagnostic tools (high‑quality ECGs, Holter monitors, echocardiography, etc.)

  • Personalised management plans — not “one size fits all” — because everyone’s symptoms, risk factors, and health background are different

  • Minimising both symptoms and anxiety: we understand that palpitations can be frightening even when benign, so reassurance is part of care

  • Follow up and monitoring: checking whether treatment is working, side effects from medications, adjusting as necessary

Book a consultation with our team in London

If palpitations are worrying you, London Heart Group can help.
Get a comprehensive cardiac assessment and peace of mind. Call us on 0208 226 5888 or email enquiries@londonheartgroup.co.uk

Contact Us