Heart Palpitations: Causes, Symptoms and When to Worry

Feeling your heart race, flutter, pound or skip a beat can be an unsettling feeling. For some people, heart palpitations happen after stress, caffeine, poor sleep or exercise. For others, they may be a sign of an irregular heartbeat or another medical issue that should be checked.

Heart palpitations are common and they are not always dangerous. Still, it is important to pay attention to when they happen, how long they last and whether they come with other symptoms like chest pain, shortness of breath, dizziness or fainting.

If your heart keeps fluttering, racing or skipping beats, a medical evaluation can help you understand what is causing the symptoms and whether your heart rhythm needs closer monitoring.

What Do Heart Palpitations Feel Like?

Heart palpitations are the feeling that your heartbeat is noticeable, unusual or out of rhythm. Some people feel them as a brief flutter. Others describe them as a racing, pounding or flip-flopping sensation in the chest.

Heart palpitations may feel like:

• Your heart is racing even when you are resting
• Your heart is pounding harder than usual
• Your heart skips a beat
• Your heart beats irregularly
• Your heart flutters or flip-flops
• You feel your heartbeat in your chest, throat or neck

These sensations can last for a few seconds, a few minutes or longer. They may happen once in a while, or they may come back repeatedly. Some people notice palpitations at night when they’re lying down. Others feel them after coffee, alcohol, stress, exercise or after eating a large meal.

Since palpitations can have many different causes, the feeling alone does not always tell you whether the problem is serious. What matters most is the pattern: how often they happen, how long they last, what seems to trigger them and whether they happen with other symptoms.

Common Causes of Heart Palpitations

Heart palpitations can happen for many reasons. Some causes are related to lifestyle, stress or temporary changes in the body. Others may be connected to heart rhythm problems or another health condition. Understanding possible triggers can help you know what to track and when to speak with a doctor.

Stress and Anxiety

Stress and anxiety are common causes of heart palpitations. When you feel anxious, overwhelmed or frightened, your body releases stress hormones that can make your heart beat faster or feel stronger than usual.

This can lead to several symptoms such as:

• A racing heartbeat
• A pounding feeling in the chest
• Chest tightness
• Sweating
• Trembling
• A sense of fear or panic attacks
• Feeling more aware of your heartbeat

This can all cause a cycle: palpitations may feel scary, which increases anxiety, which then makes the heartbeat feel even more noticeable.

Even when anxiety seems like the likely trigger, it is still worth talking with a provider if palpitations are new, frequent, worsening or happening with symptoms like chest pain, shortness of breath or fainting.

Caffeine, Alcohol and Nicotine

Caffeine, alcohol and nicotine can all make heart palpitations more noticeable for some people. These substances may affect heart rate or make the heart feel like it is racing, pounding or skipping beats.

Common triggers include things like:

• Coffee or espresso
• Energy drinks
• Pre-workout supplements
• Other sources of caffeine
• Alcohol, especially more than usual
• Cigarettes
• Vaping
• Other tobacco or nicotine products

If you notice palpitations after caffeine, alcohol or nicotine, it may help to track:

• What you had
• How much you had
• When the symptoms started
• How long the palpitations lasted
• Whether you had other symptoms, such as dizziness, chest discomfort or shortness of breath

This information can help you and your doctor understand whether there is a pattern and whether further evaluation is needed.

Lack of Sleep

Poor sleep can make your body more sensitive to stress and may make your heartbeat feel more noticeable. Some people are more aware of palpitations at night, especially when they are lying quietly in bed without distractions.

Sleep-related palpitations may be easier to notice when:

• You are overtired
• You are under stress
• You wake up suddenly during the night
• You are lying on your side
• There are fewer distractions around you

If you regularly notice palpitations at night or wake up with a racing heart, it is worth mentioning this during your visit.

Dehydration

When your body doesn’t have enough fluid, your heart may have to work harder to circulate blood. This can sometimes lead to a faster or stronger heartbeat.

Dehydration may be more likely if you have had:

• Heavy sweating
• Not enough fluids
• Vomiting or diarrhea
• Recent illness
• More caffeine or alcohol than usual

If palpitations happen during a period of dehydration or illness, those details can help your doctor understand what may be contributing to your symptoms.

Exercise or Physical Exertion

It’s normal for your heart to beat faster during exercise, climbing stairs or physical activity. That is how your body delivers more oxygen to your muscles. However, palpitations during exercise may need closer attention if they feel unusual for you, happen suddenly, continue after you stop or occur with chest discomfort, shortness of breath, dizziness or fainting.

A doctor can help determine whether your symptoms are part of a normal response to exertion or whether further testing is needed.

Hormonal Changes

Hormonal changes can sometimes make heart palpitations more noticeable. This may happen during times when the body is going through physical changes, such as:

• Pregnancy
• Menopause
• Certain points in the menstrual cycle
• Thyroid changes

The thyroid is a gland that helps regulate many body functions, including heart rate. If the thyroid is overactive, it may cause the heart to beat faster or feel irregular. If your doctor thinks hormones or thyroid function may be contributing to your palpitations, they may recommend blood work as part of your evaluation.

Medications and Supplements

Some medications and supplements can affect heart rate or trigger palpitations too. These may include certain cold medicines, asthma inhalers, stimulant medications, weight-loss products, energy supplements or herbal products.

However, you should not stop taking prescribed medication on your own. Instead, bring a full list of your medications, vitamins and supplements to your appointment with your doctor. Your provider can review whether anything you take may be contributing to your symptoms and help you decide what to do safely.

Heart Rhythm Problems

Sometimes palpitations are caused by an arrhythmia, which means the heart is beating too fast, too slow or irregularly. Some people feel palpitations as extra beats or skipped beats, while others feel a sustained racing or irregular rhythm.

One common example of an arrhythmia is atrial fibrillation, also called AFib. AFib can cause a fluttering, racing or irregular heartbeat. However, not all palpitations are AFib. Palpitations are a symptom, while AFib is just one possible diagnosis. Since rhythm problems can come and go, testing may be needed to capture what your heart is doing during an episode.

Are Heart Palpitations Dangerous?

Many heart palpitations are harmless, especially when they happen briefly and don’t come with other symptoms. However, palpitations should not be ignored if they are frequent, worsening, lasting longer than usual or happening with concerning symptoms. Your risk also depends on your medical history. Someone with known heart disease, high blood pressure, previous heart problems or a family history of rhythm issues should take that into account and may need to be more cautious.

The most important questions are:

• How often are they happening?
• How long do they last?
• What triggers them?
• Do they happen at rest or during activity?
• Do they come with chest pain, shortness of breath, dizziness or fainting?
• Do you have a history of heart disease?

A medical evaluation can help separate palpitations that are likely related to common triggers from palpitations that may need monitoring or treatment.

When Should You Worry About Heart Palpitations?

You should seek medical attention sooner if heart palpitations are new, recurrent, worsening or happening with other symptoms.

Palpitations may be more concerning if they happen with:

• Chest pain or pressure
• Shortness of breath
• Dizziness or lightheadedness
• Fainting or feeling like you might pass out
• Sweating, weakness or nausea
• A racing heartbeat that does not settle
• Palpitations that last several minutes or hours
• Symptoms during exercise
• A known history of heart disease
• A family history of serious rhythm problems or sudden cardiac events

If palpitations happen with severe chest pain, trouble breathing, fainting or symptoms that feel like a medical emergency, call 911 or seek emergency care immediately.

For less urgent but recurring symptoms, scheduling a cardiology visit can help you get clearer answers. This is especially important if the palpitations are interfering with your daily life, making you afraid to exercise or causing you to worry about your heart health.

How Doctors Evaluate Heart Palpitations

Because palpitations can have many causes, your doctor will usually start by learning more about your symptoms and medical history.

They may ask questions like:

• When did the palpitations start?
• How would you describe the feeling?
• How long do episodes last?
• How often do they happen?
• Do they occur during rest, stress, sleep or exercise?
• Do caffeine, alcohol, nicotine or certain foods seem to trigger them?
• Do they happen with chest pain, shortness of breath, dizziness or fainting?
• What medications and supplements do you take?
• Do you have a history of heart disease, thyroid problems or high blood pressure?

From there, different types of testing may be recommended depending on your symptoms.

EKG

An EKG, also called an electrocardiogram, records the electrical activity of your heart. It can help identify certain rhythm problems, especially if symptoms are happening during the test.

However, some palpitations come and go. If your EKG is normal but your symptoms continue, your doctor may recommend longer monitoring.

Heart Monitor or Event Monitor

A heart monitor can record your heart rhythm over a longer period of time. This can be helpful when palpitations happen randomly or only a few times per week.

An event monitor may be used to capture intermittent rhythm issues that do not appear during a brief office visit. This gives your doctor more information about what your heart is doing when symptoms occur.

Blood Work

Blood tests can be used to check for issues that can contribute to palpitations, such as thyroid problems, electrolyte imbalances or anemia. These tests can help your provider look beyond the heart rhythm itself and identify other possible causes.

Echocardiogram or Stress Testing

In some cases, your doctor may recommend an echocardiogram or stress test. An echocardiogram uses ultrasound to look at the heart’s structure and function. A stress test looks at how your heart responds to physical activity or exertion.

Not everyone with palpitations needs every test. The right evaluation depends on your symptoms, risk factors and medical history.

Heart Palpitations vs AFib: What’s the Difference?

Heart palpitations and AFib are related, but they are not the same thing. The simplest way to understand the difference is:

• Palpitations are a symptom. They describe the feeling that your heart is racing, fluttering, pounding or skipping beats.
• AFib is one possible cause. AFib is a type of irregular heartbeat that can cause palpitations, but not all palpitations are AFib.

AFib is important to diagnose because it can affect stroke risk and long-term heart health. If your provider suspects AFib or another heart rhythm problem, they may recommend an EKG, heart monitor or other testing.

What Can You Do If You Keep Having Heart Palpitations?

If you keep having palpitations, start by tracking them. This can make your appointment more productive and help your doctor identify possible triggers.

Write down:

• The date and time they happen
• How long they last
• What they feel like
• What you were doing before they started
• Whether you had caffeine, alcohol or nicotine
• Whether you were stressed, anxious or sleep-deprived
• Whether they happened after eating or exercising
• Any symptoms that happened with them

It also helps to note your sleep, hydration and recent illness. If you use a smartwatch or fitness tracker, you can mention any heart rate alerts or rhythm notifications to your doctor, but these devices should not replace medical evaluation.

You should also avoid making major medication changes without medical guidance. If you think a medication or supplement is causing palpitations, talk with your provider before stopping it.

When to See a Cardiologist in Queens or Brooklyn

If heart palpitations keep happening, feel unusual, come with other symptoms or are causing ongoing worry, it may be time to see a cardiologist. You should consider scheduling a cardiology evaluation if you have:

• Recurrent heart palpitations
• Palpitations with chest discomfort
• Palpitations with shortness of breath
• Dizziness, lightheadedness or fainting
• Symptoms during exercise
• A history of heart disease or high blood pressure
• A family history of rhythm problems
• Concerns about AFib or another arrhythmia

At Advanced Medical Care, our cardiology team in Queens and Brooklyn can evaluate symptoms like heart fluttering, racing, skipped beats and irregular heart rhythms. Depending on your symptoms, your visit may include an EKG, heart monitoring, blood work or additional testing to better understand what is causing your palpitations.

You do not have to guess whether your symptoms are harmless or serious. If you’re experiencing these heart symptoms, a cardiology evaluation can help you get clear answers and the right next steps. Call us at 347-571-9389 (Queens) or 929-552-2973 (Brooklyn) to schedule an appointment, or book online to get started. We are here to help you better understand your numbers and what they mean for your health.

Frequently Asked Questions About Heart Palpitations

Are heart palpitations always serious?

No, heart palpitations are not always serious. They can happen after stress, caffeine, alcohol, exercise, poor sleep or dehydration. However, palpitations should be checked if they are frequent, worsening, lasting longer than usual or happening with symptoms like chest pain, shortness of breath, dizziness or fainting.

When should I worry about heart palpitations?

You should worry about heart palpitations if they happen with chest pain, shortness of breath, dizziness, fainting, weakness or a racing heartbeat that does not settle. You should also seek medical attention if the palpitations are new, recurrent, worsening or happening during exercise.

Can anxiety cause heart palpitations?

Yes, anxiety and stress can cause heart palpitations. When your body releases stress hormones, your heart may beat faster or feel stronger than usual. However, you should not assume anxiety is the only cause if palpitations are new, frequent or happening with other symptoms.

Can caffeine cause heart palpitations?

Yes, caffeine can make palpitations more noticeable for some people. Coffee, espresso, energy drinks, pre-workout supplements and other sources of caffeine may affect heart rate. 

If you notice a pattern, track how much caffeine you had, when symptoms started and how long they lasted.

Are heart palpitations a sign of AFib?

Heart palpitations can be a symptom of AFib, but not all palpitations are AFib. Palpitations may also be related to stress, caffeine, dehydration, poor sleep, medications or other rhythm changes. 

If AFib or another arrhythmia is suspected, your doctor may recommend an EKG, heart monitor or other testing.

Should I see a cardiologist for heart palpitations?

You should consider seeing a cardiologist if heart palpitations keep happening, feel unusual, happen during exercise or come with chest discomfort, shortness of breath, dizziness or fainting. 

A cardiologist can help determine whether your symptoms are related to common triggers or a heart rhythm problem.