Heart Palpitations

Heart palpitations are sensations of your heart beating unusually fast, fluttering, pounding, or irregular heartbeat. These sensations can occur during rest or activity and may last for a few seconds or several minutes. Individuals may experience palpitations differently – some feel them in their chest, while others notice them in their throat or neck. While many people experience palpitations occasionally without harmful effects, in some cases, they may signal an underlying heart condition that requires medical attention.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG) | MRCP (UK) | MMed (Internal Med) (SG) | FAMS (Cardiology, SG)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Heart Palpitations

Patients experiencing heart palpitations may notice a variety of symptoms, which can differ in intensity and duration:

Fluttering sensation

A feeling resembles a butterfly or fluttering movement inside the chest. This sensation may be brief or persistent.
Racing heartbeat

The heart feels as if it is beating much faster than usual, even at rest. This sensation may come on suddenly or last for extended periods.
Pounding or thudding

The heartbeat feels unusually forceful against the chest wall with each beat being felt as a strong thump.
Skipped beats

The perception that the heart has missed a beat or added an extra beat in its rhythm, creating a momentary pause followed by a stronger beat.
Chest discomfort

Mild discomfort or pressure in the chest may accompany palpitations. This differs from the severe pain associated with heart attacks.
Shortness of breath

Difficulty breathing or the sensation of not being able to get enough air may occur alongside episodes of palpitations.
Dizziness or lightheadedness

Temporary feeling of unsteadiness or faintness during palpitation episodes. In severe cases, this may lead to fainting.
Anxiety

Feeling worried or panicked, often in response to unusual heart sensations, can exacerbate palpitations, creating a cycle where anxiety worsens the condition.

Causes and Risk Factors

Heart palpitations can stem from various factors ranging from everyday habits to medical conditions that affect how the heart functions.

Stress and anxiety

Emotional stress triggers the release of stress hormones, which can increase heart rate and cause palpitations. Panic attacks often feature pronounced palpitations.

Physical exertion

Vigorous exercise naturally increases heart rate and may cause noticeable palpitations. These typically resolve after the activity ends.

Caffeine consumption

Beverages like coffee, tea, and energy drinks contain caffeine that stimulates the heart. Excessive consumption can lead to palpitations.

Nicotine use

Smoking or using nicotine products speeds up the heart rate. Regular users may experience palpitations, especially after consumption.

Alcohol intake

Alcoholic beverages can disrupt normal heart rhythm. Binge drinking, in particular, increases the risk of developing palpitations.

Medications

Certain drugs, such as decongestants, asthma treatments, and some antibiotics, may trigger palpitations as a possible side effect.

Hormonal changes

Fluctuations during menstruation, pregnancy, or menopause can trigger palpitations. Thyroid hormone imbalances also affect heart rhythm.

Electrolyte imbalances

Low levels of potassium, magnesium, or other essential minerals disrupt electrical signalling in the heart. This commonly occurs with dehydration or certain medical conditions.

Heart conditions

Arrhythmias, valve disorders, heart failure, and structural heart problems can all cause palpitations.

Other medical conditions

Anaemia, fever, low blood pressure, and certain lung conditions may lead to palpitations as the body compensates for reduced oxygen delivery.

Diagnostic Methods

Physical examination

Vital signs, including heart rate, rhythm, and blood pressure, are assessed while listening to heart sounds. The examination may detect murmurs, irregular beats, or other abnormalities. Additional signs of thyroid disorders, anaemia, or other conditions that affect heart rhythm may also be noted.
Electrocardiogram (ECG)

Records the heart’s electrical activity through electrodes placed on the chest and limbs. It provides a snapshot of heart rhythm, helping to detect arrhythmias, structural abnormalities, or signs of previous heart damage.
Holter monitor

A portable ECG device worn for 24 to 48 hours, continuously tracking heart activity during daily routines. A symptom diary helps correlate palpitations with recorded data, aiding in the identification of intermittent irregularities.
Event recorder

A wearable device used for longer periods (up to 30 days), recording heart rhythm only when activated during symptoms. This is useful for infrequent palpitations that may not be captured through shorter-term monitoring.
Echocardiogram

An ultrasound scan that creates images of the heart’s structure and function. It evaluates valve function, chamber size, and muscle performance, helping to identify structural abnormalities that may contribute to palpitations.
Exercise stress test

This test monitors heart rhythm, blood pressure, and symptoms while walking or cycling under progressively increasing exertion. It helps determine if physical activity triggers palpitations or reveals hidden arrhythmias.
Blood tests

Assess factors such as thyroid function, electrolyte levels, and blood cell counts to identify potential causes of palpitations, such as hormonal imbalances, mineral deficiencies, or anaemia.
Electrophysiology study (EPS)

This procedure maps the heart’s electrical pathways using catheters inserted through blood vessels. It is used to identify arrhythmias and guide treatment options.

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Treatment Options

The management of heart palpitations depends on the underlying cause, severity, and frequency of symptoms.

Non-Surgical Treatment

Lifestyle modifications: Avoiding stimulants such as caffeine, alcohol, and nicotine can reduce the frequency of palpitations. Managing stress through techniques like deep breathing, yoga, and regular exercise may help regulate heart rhythm. Maintaining a consistent sleep schedule and avoiding sudden changes in activity levels can also be beneficial.
Hydration and electrolyte balance: Ensuring adequate hydration and maintaining stable levels of essential minerals, such as potassium, magnesium, and calcium, can support normal heart function. Electrolyte imbalances, often caused by dehydration, excessive sweating, or certain medications, can contribute to irregular heartbeats.
Medications: Beta-blockers or calcium channel blockers may be used to slow heart rate and stabilise rhythm in cases of frequent palpitations. Anti-arrhythmic drugs may be prescribed for individuals with persistent or more complex arrhythmias. Medications for underlying conditions, such as thyroid hormone replacement for hypothyroidism or iron supplements for anaemia, may also be necessary.
Treatment of underlying conditions: Managing medical issues that contribute to palpitations can help alleviate symptoms. Conditions such as hyperthyroidism, anaemia, high blood pressure, and anxiety disorders may require specific treatments to restore normal heart function.
Catheter ablation: This minimally invasive procedure is used to treat arrhythmias that do not respond to medication. A catheter is inserted into a blood vessel and guided to the heart, where heat or cold energy is applied to destroy abnormal electrical pathways causing irregular rhythms. This procedure is commonly used for supraventricular tachycardia, atrial fibrillation, and other arrhythmias.

Surgical Treatment

Pacemaker implantation: A small device is placed under the skin of the chest to regulate slow or irregular heartbeats by sending electrical signals to the heart. This is often used for bradycardia (slow heart rate) or heart block.
Implantable cardioverter-defibrillator (ICD): A device that monitors heart rhythm and delivers an electrical shock when it detects life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation.
Maze procedure: A surgical technique where small incisions or ablations are made in the heart tissue to create a controlled scar pattern, disrupting abnormal electrical signals. This is primarily used for persistent atrial fibrillation that does not respond to other treatments.
Valve repair or replacement: If palpitations are caused by valve disease, surgical intervention may be required to repair or replace a damaged heart valve in order to restore normal blood flow and heart rhythm.
Coronary artery bypass grafting (CABG): The procedure is used for coronary artery disease by improving blood flow to the heart. It involves bypassing blocked arteries, reducing strain on the heart, and minimising rhythm disturbances.

Prevention and Management

Preventing and managing heart palpitations involves lifestyle adjustments and addressing triggers. Regular exercise helps strengthen the heart, while proper hydration can prevent electrolyte imbalances. Reducing stimulants like caffeine, nicotine, and alcohol minimises common triggers, and consistent sleep patterns support heart function. Stress management techniques, such as deep breathing or meditation, can reduce anxiety-related palpitations. For individuals with heart conditions, adherence to prescribed medications and regular check-ups are essential for ongoing monitoring. Keeping a symptom diary helps identify patterns, and wearing a medical alert bracelet may be beneficial for those with serious arrhythmias.

Frequently Asked Questions (FAQ)

When should I seek emergency care for heart palpitations?

Immediate medical attention is required if palpitations occur with chest pain, severe shortness of breath, dizziness, or fainting, as these may signal a serious heart condition. Emergency care is also advisable if palpitations persist for several hours or if there is a history of heart disease.

Can pregnancy cause heart palpitations?

Pregnancy increases blood volume and cardiac output, making palpitations common, even in healthy women. Hormonal changes further affect heart rhythm. These palpitations typically resolve after delivery, but should still be discussed with a healthcare provider.

Is lifelong medication necessary for heart palpitations?

The need for medication depends on the underlying cause. Temporary triggers like stress or caffeine may not require long-term treatment. Chronic conditions such as atrial fibrillation often need ongoing medication. Some structural heart conditions may necessitate lifelong medication, while patients who undergo ablation may eventually stop treatment.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG)|MRCP (UK)|MMed (Internal Med) (SG)|FAMS (Cardiology, SG)

A Senior Consultant Cardiologist specialising in interventional cardiology and serves as the Medical Director at Carrington Cardiology, located at Mount Elizabeth Medical Centre in Singapore.

Dr. Kua obtained his MBBS from the National University of Singapore. He furthered his medical education by earning an MRCP in the UK and an MMed in Internal Medicine from NUS. He completed advanced training in interventional cardiology at Hammersmith Hospital in London.
Dr. Kua’s international training at Hammersmith Hospital provided him with extensive experience in complex coronary interventions and exposure to advanced cardiovascular research. He served as an International Cardiology Fellow and Honorary Consultant during his tenure there.

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