Causes of palpitations: what can be behind them, the warning signs and what the GP usually finds

In this article you read what causes heart palpitations, which signs mean you call your GP straight away, and what research finds when people with heart palpitations are examined. That matters, because suddenly feeling your heartbeat is unsettling, and if you know the common causes of heart palpitations, you can better judge when action is needed. Heart palpitations are common: according to a review of primary care, they account for about one in six of the complaints people bring to their GP, and they are the second most common complaint at the cardiology outpatient clinic.⁠³ The BioProfile heart and blood vessel scan gives you an indication of where you stand today in this area. This is not a diagnosis. It is insight, to see where you stand today and to help you make better choices in your diet and lifestyle. The scan does not record your heart rhythm and does not identify a cause. Only a doctor can do that.

Everyday causes of palpitations

Thuisarts, the public website of Dutch GPs, says that heart palpitations are usually not dangerous. The everyday causes the site lists are exertion and sport, coffee, cola, energy drinks and other drinks with caffeine, smoking, drugs, alcohol, fatty food, pain, emotions, tiredness, stress and anxiety.⁠¹ The self-care advice follows from that list: note when the palpitations come, cut down on alcohol, caffeine and smoking, and do something about stress and anxiety.⁠¹

Put simply: most palpitations are your heart reacting to something you did or felt that day. Keeping track of when they come is the first useful step.

Medical causes

Thuisarts also lists medical causes: fever, thyroid conditions, pneumonia, anaemia, allergy, heart disease, atrial fibrillation, high blood pressure, diabetes, and side effects of medicines such as prednisone, ADHD medicines and asthma medicines.⁠¹

How often is it the heart? In 190 people in a row who came to a university medical centre with palpitations, a cause was found for 84%. In 43% it was the heart, in 31% the cause was psychiatric, in 10% it was something else, and in 16% the cause stayed unknown.⁠² In the year after, 1.6% died and 1.1% had a stroke, while three in four had palpitations again.⁠² A 2024 review written for primary care reports that studies link palpitations in people outside hospital with few deaths and few heart problems.⁠³

What this means for you: palpitations often come back, but a serious outcome was uncommon. Their coming back is not in itself a sign of danger.

When to call your GP straight away

Call your GP or the out-of-hours GP service straight away if palpitations come with any of these signs:⁠¹

• pain or pressure in the chest that does not go away after a few minutes
• confusion, difficulty speaking or worse vision
• restlessness, nausea, sweating or looking pale
• difficulty breathing
• the feeling that you are about to faint
• a heartbeat that suddenly feels different from normal and does not calm down when you sit quietly for a while

Thuisarts calls a resting heart rate of 60 to 90 beats per minute normal.⁠¹ You can read what a normal heart rate is at different ages on our statistics page.

Palpitations from stress and anxiety

Of 145 people with palpitations who were referred to have their heart recorded for 24 hours, almost half had had an anxiety disorder or a depressive disorder at some point in their life, and about a quarter had one in the past month. Panic disorder was the most common: more than a quarter had had it at some point.⁠⁴ People with one of these disorders more often described their palpitations as pounding, and more often felt faint, light-headed or dizzy. Their heart history and ECG results were no more serious than everyone else’s.⁠⁴

Put simply: stress and anxiety can make your heartbeat feel stronger and more worrying, without the heart itself being in worse shape. Feeling that you are about to faint is still one of the signs to call your GP for, so have a doctor assess that combination.

Palpitations during the menopause

The American SWAN study followed 3,276 women through the menopause transition. About one in six had a high chance of palpitations from perimenopause into early postmenopause, and about a third had a moderate chance. In both groups, that chance went down later on. The other half had a low chance the whole time.⁠⁵ At the start, the high-chance group had more hot flushes and night sweats, more depressive symptoms, more stress, more sleep problems and higher blood pressure.⁠⁵ In 1,559 of the women whose blood vessels were later measured, the palpitation patterns were not linked to thickening of the carotid arteries or to stiffer blood vessels.⁠⁵

What this means: palpitations around the menopause are common, usually pass and tend to come with hot flushes, stress and poor sleep. Thuisarts covers hot flushes during the menopause on the same page.⁠¹ You can read more about how heart symptoms can show up differently in women in heart symptoms in women.

Coffee and extra heartbeats

In a trial, 100 adults wore a heart monitor for 14 days and were told each day by text message either to drink caffeinated coffee or to avoid caffeine. Extra beats from the upper chambers of the heart happened about equally often on both kinds of day. Extra beats from the lower chambers happened more often on coffee days, about 154 a day against 102, and people walked about 1,000 more steps.⁠⁶

Put simply: coffee did not change every type of extra heartbeat, but it did add some. If you notice palpitations after coffee, that is worth writing down.

What the GP usually finds

In the study of 190 people, the cause could be found in 40% using only questions, a physical examination, an ECG and a blood test.⁠² In a Dutch trial in general practice, a small recording device that patients switched on themselves during an episode found a relevant heart rhythm disorder about three times as often as usual care alone, and far fewer people were left without a cause.⁠⁷ A second Dutch study of 127 patients found that GPs’ own judgement of who had a heart rhythm disorder did not match what the recordings showed, so GPs need easy access to heart rhythm recording.⁠⁸

What this means for you: a normal check-up at the surgery does not always give you a clear answer. A recording made during an attack often tells you more.

In summary

In this article you read about the everyday and medical causes of heart palpitations, the signs that mean you call your GP straight away, the role of stress, anxiety, the menopause and coffee, and what the GP usually finds. Heart palpitations are common, often come back and are usually not dangerous. The heart and blood vessel scan gives you a starting point for self-insight, and a doctor looks for the cause.