Heart palpitations and irregular beats
Most of the time we are not aware of our own heart. Palpitations are what we call the moment it becomes audible: it pounds, races, stumbles, seems to drop a…
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Medicines commonly prescribed for Heart palpitations and irregular beats
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 100 mgActive substance: metoprololManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: INJECTABLE, 150 mg/3 mlActive substance: amiodaroneManufacturer: Sanofi Aventis S.A.Prescription requiredDosage form: TABLET, 200 mgActive substance: amiodaroneManufacturer: Aurovitas Spain, S.A.U.Prescription required
Most of the time we are not aware of our own heart. Palpitations are what we call the moment it becomes audible: it pounds, races, stumbles, seems to drop a beat, or beats so hard that the pulse can be felt in the neck and throat. The sensation itself is not a diagnosis. It happens to entirely healthy people after one coffee too many, a sleepless night or a fright, and it can also be the only outward sign of a rhythm disturbance that needs to be found. What separates those two situations is not how strong the feeling is: a very unpleasant episode may be harmless, while barely noticeable irregular beats may matter a great deal. The difference lies in the circumstances of the episode and in what comes with it.
What palpitations feel like
People describe them differently, and those differences genuinely mean different things. The pulse may be fast but perfectly regular, like a drum. There may be isolated hiccups: the heart seems to skip a beat and then delivers one strong thump — that is how ectopic beats feel, and they are the commonest reason anyone reads a page like this. There may be a regular but unusually forceful beat that keeps you awake. And there may be a fluttering that is quick, fine and clearly disorganised.
Four things are worth noticing, because they are exactly what a doctor will ask about.
- The rhythm. Do the beats come at even intervals or at random? A fast, disorganised pulse is a separate matter and more often needs investigating.
- The start and the finish. Does the episode build up and settle gradually, or switch on and off instantly, as though someone flicked a switch?
- How long it lasts. Seconds, minutes, hours?
- The circumstances. At rest, at night, after coffee, during a fright — or during physical exertion?
Episodes that start and stop instantly, and episodes tied to exertion, are looked at separately and more carefully than the rest.
When to call an ambulance
The single European emergency number is 112. Call it if you have palpitations right now together with:
- pain, pressure, tightness or burning in the chest, spreading to the arm, jaw, neck or back;
- breathlessness, air hunger, or being unable to finish a sentence;
- fainting, or something very close to it: vision darkening, the floor seeming to move, having to sit or lie down to avoid falling;
- sudden weakness, cold sweat, pallor, confusion;
- an episode that began during physical exertion and is not settling;
- a very fast pulse lasting more than a few minutes and not calming at rest.
Do not drive yourself, and do not be driven, if you feel faint: wait for the crew lying down or propped up. Gather the packets of any medicines you take, because you will be asked about them. If someone beside you collapses and is not breathing normally, start chest compressions and do not stop until help arrives.
What must not be missed, even once the episode is over
The commonest mistake is to relax because it has passed. Some features need looking into regardless of how you feel now, and they warrant an appointment rather than waiting for the next time.
- Fainting, or nearly fainting, during an episode — even once, even months ago. It means that while the rhythm was disturbed the brain was left short of blood flow.
- Palpitations that come on specifically with exertion: climbing stairs, running, heavy work. A rising pulse during exercise is normal; what is not normal is an episode firing off instead of a steady rise, or the pulse turning irregular on exertion.
- Episodes with an abrupt start and an equally abrupt end. A very fast, regular pulse that arrives in a single beat and, minutes or hours later, cuts out just as suddenly is the classic picture of paroxysmal supraventricular tachycardia. It responds well to treatment, but first it has to be captured on a recording.
- Sudden death at a young age in close relatives, along with unexplained drowning, death during sleep or serious arrhythmias in the family. This is a reason for assessment in its own right, and it is worth volunteering rather than waiting to be asked.
- An already known heart condition: a previous heart attack, a valve problem, cardiomyopathy, heart surgery, heart failure.
- Irregular beats that have appeared recently and are becoming more frequent, particularly alongside worsening breathlessness, swollen ankles or falling stamina.
Why healthy people get them
Most episodes are explained by something on this list. But a "harmless" cause can still need treating: anaemia and an overactive thyroid are here because they do not arise from the heart itself, not because they can be left alone.
- Caffeine: coffee, strong tea, energy drinks, some combined painkillers and cold remedies.
- Nicotine, alcohol — especially the morning after a heavy session — and stimulants.
- Too little sleep and physical exhaustion.
- Anxiety and panic attacks; here the palpitations usually come with trembling, tingling fingers and a feeling of not getting enough air.
- Exercise, and the first few minutes after stopping.
- Fever: as the temperature rises, the pulse predictably speeds up.
- Dehydration, standing up quickly, heat, saunas.
- Iron deficiency anaemia — the heart makes up for a shortage of oxygen with speed.
- An overactive thyroid: palpitations arrive together with sweating, tremor, weight loss despite a good appetite and poor tolerance of heat.
- Pregnancy and the menopause.
- Medicines: decongestant drops and tablets, bronchodilator inhalers, thyroid hormone, some antidepressants and weight-loss products. Sometimes the culprit is not the tablet but stopping it abruptly.
How to capture an episode
The central difficulty with palpitations is that you arrive at the appointment well: the episode comes and goes with no witnesses, and an ordinary electrocardiogram shows only the few seconds it is running. So a great deal depends on what you manage to record yourself.
- Count your pulse during the episode. Fingers on the wrist on the thumb side, or at the side of the neck; count a full minute rather than fifteen seconds, because with an irregular rhythm a short count is misleading.
- Note whether it is regular or not. This is one of the most valuable lines in your account. It is enough to hear whether the beats come evenly or out of step.
- Write down the circumstances: date and time, what you were doing, what you had eaten or drunk, how long it lasted, how it ended and what else you felt besides the beat itself.
- If your watch or phone can record a trace, take one during the episode and keep the recording file rather than a photograph of the screen. It does not replace proper testing, but it often answers the key question about rhythm straight away.
After that the doctor decides how to catch the episode: a twenty-four-hour or multi-day recording, a monitor worn for weeks and triggered when symptoms strike, or an exercise test if episodes are tied to exertion. Blood tests usually cover haemoglobin, thyroid function, potassium and magnesium, and sometimes glucose, reported here in mmol/L. An ultrasound scan of the heart shows its structure and function rather than the rhythm.
What is sensible to do yourself
While the cause is being worked out, simple measures help. Cut down caffeine, but gradually: stopping it abruptly causes headache and palpitations of its own for a few days. Reduce alcohol and give up nicotine. Sort out your sleep and drink enough water. Do not start potassium, magnesium or "heart support" supplements on your own initiative: with normal blood tests they are unnecessary, and in some conditions they are not harmless. Above all, never stop a prescribed medicine by yourself — with several of them abrupt withdrawal causes exactly what you are trying to escape. Discuss any change with your doctor.
The manoeuvres that can break an episode — holding the breath while straining, splashing the face with very cold water — do exist. But they should be taught by a doctor, and only once it is clear which rhythm disturbance you have: for some kinds they are useless, and after any fainting spell they are not safe. Massaging your own neck is not something to try.
Online consultation
Palpitations are a subject where talking gets further than examining. Remotely, a doctor can go through the rhythm and the circumstances of your episodes, separate an anxiety response from a rhythm disturbance, review your medicine list and find what may have set it all off, explain which tests make sense in your case and in what order, and read through any traces, letters and monitor reports you already have to tell you what matters in them. A further benefit is being taught to count and describe your pulse properly, so that the next episode is not wasted.
The limits of the format are worth stating plainly: a screen cannot record a trace, listen to your heart or confirm an arrhythmia. And if palpitations come with chest pain, breathlessness or fainting, or started during exertion, what is needed is an ambulance rather than a message.
This material is for information only and does not replace medical advice.
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