Palpitations: when to worry

Palpitations — an awareness of your own heartbeat — are one of the most common reasons people see a cardiologist. The great majority are harmless. The purpose of assessment is to identify the small number that point to an underlying rhythm disturbance worth treating.

What palpitations can feel like

People describe them in many ways: a thump, a flutter, a racing sensation, a skipped or missed beat, or a pause followed by a strong beat. The description often gives useful clues about the underlying cause.

Reassuring features

Palpitations are more likely to be benign when they are brief, occur as isolated extra beats (often felt at rest or when lying down), settle on their own, and are not accompanied by other symptoms.

Features that warrant assessment

It is worth seeking a structured review if palpitations:

• are sustained and rapid, with a sudden on and off
• are associated with chest pain, severe breathlessness, or fainting
• occur during exertion
• happen in the context of known heart disease or a family history of sudden cardiac death

How assessment works

The key to diagnosis is capturing the heart rhythm during symptoms. This may involve an ECG, a period of ambulatory monitoring, or — for infrequent episodes — a longer-term recorder. The history, examination, and these recordings together usually establish whether treatment is needed.

If you faint, develop chest pain, or become severely breathless, call 999.

This article is for general information and is not a substitute for individual medical advice. Reviewed by Dr Iain Sim.

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