Heart palpitation symptoms: what they mean, what your GP finds and when to call straight away

In this article you will read about the symptoms of palpitations: what they feel like, what usually lies behind them, how palpitations differ from an arrhythmia and when to call a doctor straight away. That matters, because most palpitations are harmless, but a few signs mean you should call right away, and knowing the difference saves you worry and time.⁠¹ The BioProfile heart and blood vessel scan gives you an indication of where you stand today when it comes to heart health. It is insight, to see where you stand and to help you make better choices in your diet and lifestyle. The scan is not a diagnosis. Finding a cause is work for a doctor.

Heart palpitation symptoms: how it feels

At rest, when you are sitting still, an adult’s heart normally beats 60 to 90 times a minute.⁠¹ You can read more about that number in normal heart rate. Palpitations are the moments when your heart suddenly seems to beat differently from normal.⁠¹

The studies describe the symptoms palpitations cause in people who see a doctor. Some feel episodes that disturb their sleep or come on at work, some feel short episodes of less than five minutes, and some feel a regular, fast pounding in the neck.⁠⁵ Others feel light-headed, or faint and clammy.⁠³ In plain words: palpitations are not a single feeling. They are a group of feelings, and each one says something different about what may lie behind it.

What usually causes palpitations

Thuisarts lists the common causes: caffeine from coffee, cola or energy drinks, alcohol and smoking, physical exertion, stress, anxiety and emotions, a thyroid that is not working properly, anaemia, arrhythmias, high blood pressure and side effects of medicines.⁠¹ Physical exertion is on that list, and that is no reason to sit still; you can read what too little movement does to your body in what too little movement does to your body.

In an American study of 190 patients who came to hospital with palpitations, the cause lay in the heart for 43 percent, the cause was psychological for 31 percent, something else for 10 percent, and for 16 percent the cause remained unknown.⁠² So for about half of these patients, the cause lay outside the heart or was never found.

Palpitations or a heart rhythm disorder?

Palpitations are what you feel. An arrhythmia is what a recording of the heart shows. The two often do not match. In 41 Dutch GP practices, 127 patients with palpitations or light-headedness first had a consultation, an examination and an ECG, and then wore a small device that records the heart rhythm for thirty days. The GPs’ assessment of who had an arrhythmia did not match what the recordings showed.⁠³ Feeling faint or clammy and a slow heartbeat were more common in the people whose recording did show an arrhythmia.⁠³

A large review found the same. A known heart condition, palpitations that disturb sleep and palpitations at work made a heart rhythm disorder somewhat more likely; a history of panic disorder and episodes shorter than five minutes made one less likely. A regular, fast pounding in the neck made a particular fast rhythm much more likely. The researchers conclude that in most patients, the history and examination alone cannot rule out a meaningful heart rhythm disorder.⁠⁵ What this means for you: how palpitations feel gives a clue, and only a heart rhythm recording gives the answer.

The best-known heart rhythm disorder is atrial fibrillation. In the Rotterdam Studie, among 6,808 people aged 55 and over, 5.5 percent had atrial fibrillation, rising from less than 1 percent at 55 to 59 to almost 18 percent at 85 and over.⁠⁶ Of 6,432 people followed for about seven years, 437 developed atrial fibrillation, more often men than women.⁠⁶ You can read which heart symptoms women notice in heart symptoms in women. For men and women aged 55, the lifetime chance of developing atrial fibrillation was about 1 in 4 in both groups.⁠⁶ Put simply, atrial fibrillation is a common condition that becomes even more common with age.

When to call your GP straight away

Call your GP or the out-of-hours GP service straight away if, along with the palpitations, you have 1 or more of these: pain or a pressing feeling on or in your chest that does not go away after a few minutes; confusion, difficulty speaking, reduced vision or a drooping mouth; a restless feeling with nausea, sweating and a pale face; difficulty breathing; the feeling that you are about to faint; or a heart that suddenly beats differently from normal and does not settle when you sit quietly for a moment.⁠¹

What a recording can find

A conversation, an examination, an ECG and a blood test together found the cause in 40 percent of patients in the American study.⁠² A heart rhythm recording adds a lot. In a Dutch study in general practice, with a small device patients switched on themselves during an episode, 17 percent were left without an explanation, against 38 percent with usual care alone. A cause in the heart was found clearly more often, and relevant heart rhythm disorders about three times as often.⁠⁷ In plain words: when a symptom comes and goes, recording it in the moment explains it.

Time matters too. Of 127 Dutch patients who wore a monitor for thirty days, 82 per cent recorded at least one episode, and three quarters of all findings had been made after two weeks. The researchers advise recording for at least two weeks.⁠⁴ A review found that a Holter recording found the cause of the symptoms in about a third of patients, and that monitors that switch on by themselves found heart rhythm disorders more often than monitors the patient switches on. Which device suits you depends on your symptoms and on you as a person.⁠⁸ Loop recorders, which were worn for longer, gave the most results: they found a heart rhythm disorder in 34 to 84 per cent of patients.⁠⁵

The outlook is largely calm. Within a year, 3 in 4 patients in the American study had palpitations again, while 9 in 10 said their health had stayed the same or improved; 1.6 percent died and 1.1 percent had a stroke.⁠² For most people, palpitations come back now and then without their health getting worse.

What the heart scan measures and what it does not

The heart scan gives you a picture of where you stand today on heart health, as a starting point you can come back to later. A scan on a screen cannot record a heartbeat. The scan cannot tell an extra beat apart from atrial fibrillation or from a racing heart caused by stress; for that you need a heart rhythm recording, as the studies above show.⁠⁵ The scan is self-insight. The scan is not a diagnosis.

In summary

Palpitations are moments when your heart seems to beat differently, and in most cases palpitations are harmless. Behind palpitations are coffee, alcohol, exertion, stress and a few medical causes. How palpitations feel gives a clue about the rhythm, and only a recording, ideally for about two weeks, shows the rhythm. The warning signs from Thuisarts tell you when to call straight away. The heart scan gives you a starting value for your heart health.