Heart Palpitations
A thud, a flutter, a skipped beat, or a heart that suddenly races. Palpitations are common and usually harmless, often set off by caffeine, stress or lack of sleep. Some need checking, and a few need urgent聽help.
What they feel like: racing, pounding, fluttering or irregular beats, felt in the chest, neck or throat. They can last seconds, minutes or longer.
Common triggers: caffeine, alcohol, nicotine, recreational drugs such as cocaine and amphetamines, stress and anxiety, lack of sleep, hard exercise, fever and some medicines, including asthma relievers and ADHD medicines. Pregnancy and menopause can bring them on too.
Medical causes: skipped or extra beats (ectopic beats), heart rhythm problems such as atrial fibrillation, an overactive thyroid, anaemia, low blood sugar and, less often, heart valve or heart muscle problems.
The palpitations ladder
Most palpitations need trigger-spotting, not treatment. The key test is catching the heart rhythm during symptoms.
- Step 1 路 Self-careSpot and cut the triggersTrack when palpitations happen and what came before. Cut back on caffeine and alcohol, stop smoking and vaping, get enough sleep, and check the leaflets of any medicines you take. During an episode, sit down, rest and loosen tight clothing.
- Works
- Often all that鈥檚 needed when no heart problem is found
- Cost
- Free
- How long
- A few weeks to notice a pattern
- Watch for
- Don鈥檛 stop prescribed medicines without talking to your doctor.
Your heart鈥檚 just reporting on your third coffee.
- Step 2 路 GPExamination, ECG and blood testsYour GP asks about your symptoms and family history, checks your pulse and blood pressure, does an ECG (heart tracing), and may test thyroid, blood count and iron.
- Works
- An ECG during symptoms can show the rhythm directly; blood tests find thyroid and anaemia causes
- Cost
- Medicare rebates for the visit and tests
- How long
- Same visit for the ECG; days for results
- Watch for
- Note the date and time of episodes to show your GP.
Ten sticky dots and a lot of reassurance.
- Step 3 路 Specialist testsHeart monitor and ultrasoundA Holter monitor records your heart for 1 to 2 days. Event monitors are worn for longer, and a tiny recorder can go under the skin for months. A heart ultrasound checks structure.
- Works
- Most useful when episodes are frequent enough to catch
- Cost
- Partly Medicare-covered; gap fees vary
- How long
- Days to months
- Watch for
- Press the button or note the time when symptoms happen.
The trick is catching it in the act.
- Step 4 路 SpecialistTreatment for a heart rhythm problemIf a cardiologist finds a rhythm problem, treatment can include medicines, a procedure to fix the faulty electrical pathway, or a device.
- Works
- Effective for the specific rhythm problem found. Many people need no treatment at all
- Cost
- Specialist fees vary; Medicare rebates with a referral
- How long
- Depends on the cause
- Watch for
- Ask about the risks and benefits of each option.
Targeted fixes for real faults. Not every flutter is one.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Energy drinks and high-caffeine pre-workoutsCaffeine is a common trigger. Cutting back is cheaper than any test.
- Cigarettes, vapes and nicotine pouchesNicotine is a known trigger.
- Recreational stimulantsCocaine and amphetamines can cause palpitations and dangerous heart rhythms.
What you can do
- Keep a diary of episodes: time, length, what you were doing, and any triggers.
- Cut back on caffeine and alcohol, and quit smoking. Our quitting smoking fact sheet can help.
- Prioritise sleep and stress management.
- If anxiety is a big part of it, read our anxiety fact sheet.
- Find out whether anyone in your family has a heart rhythm problem.
See your GP if
- Palpitations keep coming back or are happening more often
- They last more than a few minutes
- You have a heart condition, or a family history of heart rhythm problems
- You take a medicine, such as an asthma reliever or ADHD medicine, that might be a trigger
Call 000 (Australia) or your local emergency number if palpitations come with chest pain, shortness of breath, dizziness or light-headedness, or fainting or blacking out, or if they don鈥檛 go away. Don鈥檛 drive yourself to hospital.
Common questions
Are heart palpitations dangerous?
Usually not. Most are caused by triggers like caffeine, stress or lack of sleep, or harmless extra beats. See a doctor if they keep happening or last more than a few minutes, and call an ambulance if they come with chest pain, breathlessness or fainting.
What does a skipped heartbeat mean?
Usually an extra beat (an ectopic beat) followed by a pause, which makes the next beat feel stronger. They are common and usually harmless, but a GP can check with an ECG.
Can anxiety cause palpitations?
Yes. Stress, anxiety and panic attacks are common causes. A doctor may still check your heart to be sure.
What tests are done for palpitations?
An ECG and blood tests first. If episodes come and go, a heart monitor worn for 1 to 2 days or longer can catch the rhythm. Some people also have a heart ultrasound.
Helpful resources
- healthdirect: Heart palpitationsCauses, tests and when to call 000. Free, Australia.
- NHS: Heart palpitationsTriggers and when to get help. Free, UK.
- Atrial fibrillation fact sheetThe most common heart rhythm problem. Free, from us.
Evidence and more information
maladywise.com/palpitations/