Heart palpitations are feelings that your heart is beating too hard, too fast, skipping beats, or fluttering. Most palpitations are harmless, but some point to heart arrhythmias or other medical issues. We explain common causes, what distinguishes benign from concerning palpitations, how clinicians evaluate them, and what to expect if you see a cardiologist in New York.
What are heart palpitations
Heart palpitations describe a noticeable awareness of the heartbeat. People use several words for the sensation, including skipped beats, pounding, fluttering, or racing. Palpitations can occur at rest, during activity, or while lying in bed. The sensation comes from irregular timing, an unusually strong contraction, or a faster than normal rate.
How palpitations relate to cardiac rhythm
Palpitations may reflect an extra beat such as a premature ventricular contraction, a run of fast beats from above the ventricles like supraventricular tachycardia, or sustained rhythm problems including atrial fibrillation. Not every palpitation means a dangerous rhythm. Determining the rhythm requires testing such as an electrocardiogram or ambulatory monitoring.
Why palpitations matter locally
In a dense urban environment like New York, many triggers for palpitations are common. Caffeine, irregular sleep, stress from work, alcohol, and intense commuting can bring episodes on. At the same time, cardiovascular risk factors such as high blood pressure, elevated cholesterol, diabetes, and older age raise the chance that palpitations signal an underlying heart condition.
Because we focus on preventing heart attack, stroke and sudden cardiac events, palpitations are an important symptom for our practice. With more than 30 years of clinical experience, we balance ruling out urgent problems and identifying long term risks that benefit from targeted prevention.
Key concepts to understand
- Benign triggers. Caffeine, nicotine, alcohol, exercise, anxiety and some medications often cause harmless palpitations.
- Extra beats. Premature atrial contractions and premature ventricular contractions are common and often benign, but frequency and symptoms matter.
- Sustained arrhythmias. Atrial fibrillation, atrial flutter and supraventricular tachycardia usually need evaluation and treatment to reduce stroke and symptom burden.
- Associated conditions. Thyroid disease, anemia, low blood sugar, dehydration and electrolyte imbalances can cause palpitations.
- Risk profile. Age, hypertension, diabetes and prior heart disease change the urgency and type of testing we recommend.
Common causes of heart palpitations
Palpitations come from cardiac and non cardiac causes. Below we list frequent triggers and medical conditions you will hear about when you see a heart specialist.
- Stimulants and lifestyle. Caffeine, nicotine, energy drinks and recreational drugs can provoke palpitations. Alcohol, large meals and intense exercise are also common triggers.
- Anxiety and panic. Emotional stress or panic attacks often produce racing heart sensations with sweating or shortness of breath.
- Extra heartbeats. Premature atrial contractions and premature ventricular contractions are common, often isolated, and may not require treatment unless frequent or symptomatic.
- Atrial fibrillation and supraventricular tachycardia. These sustained rhythm disturbances produce persistent or recurrent palpitations and may cause lightheadedness or shortness of breath.
- Medication effects. Some prescription and over the counter medicines, including decongestants and thyroid replacement, can increase heart rate or cause irregular beats.
- Systemic medical conditions. Overactive thyroid, anemia, low blood sugar, electrolyte problems and fever can all lead to palpitations.
- Structural heart disease. Coronary artery disease, cardiomyopathy and valve disease raise the likelihood that palpitations represent a clinically significant arrhythmia.
How clinicians evaluate palpitations
We start by listening to the symptoms and the context. The goal is to separate benign, intermittent palpitations from rhythm problems that need treatment or risk reduction.
- History and symptom review. We ask when palpitations happen, how long they last, associated symptoms such as chest pain or fainting, and triggers like caffeine or stress.
- Physical exam and baseline testing. A focused cardiac exam and a resting electrocardiogram give immediate information about rhythm and conduction.
- Ambulatory monitoring. If palpitations are intermittent, we use tools such as 24 to 48 hour Holter monitors or longer event monitors to capture episodes while you go about your day.
- Advanced testing. When indicated, we recommend echocardiography to examine structure, laboratory tests for thyroid function and electrolytes, and stress testing or coronary CT angiography for suspected coronary disease.
- Risk assessment and plan. Combining test results with risk factors such as high blood pressure, diabetes and age allows us to recommend observation, lifestyle changes, medication adjustments or referral for electrophysiology procedures when needed.
Pro tip: Keeping a short diary of when palpitations occur, how long they last and any activities or foods beforehand makes it easier for a clinician to identify likely triggers and choose the right monitoring strategy.
When palpitations are urgent
Most palpitations are not life threatening. Seek immediate medical attention when palpitations come with any of the following:
- Fainting or near fainting.
- Severe chest pain or pressure.
- Sudden shortness of breath that is new or worsening.
- Palpitations after a known heart attack or in someone with known heart failure.
Watch out: New onset palpitations in someone with known coronary artery disease, prior stroke or significant valve disease need prompt evaluation by a cardiovascular specialist.
What to bring and what we look for
Before an appointment
- Note the timing and triggers of recent palpitations.
- Bring a list of medications and supplements.
- Record any history of heart disease, high blood pressure, high cholesterol or diabetes.
In clinic we focus on correlating symptoms with rhythm, evaluating risk factors such as hypertension and elevated cholesterol, and deciding whether ambulatory monitoring or imaging is needed. When testing shows atrial fibrillation, we discuss stroke risk and treatment options to reduce that risk.
Benign versus concerning palpitations comparison
| Feature | Likely benign | Potentially concerning |
|---|---|---|
| Timing | Short isolated episodes, often with stimulants or anxiety | Frequent runs, sustained fast rate, or episodes associated with fainting |
| Associated symptoms | No dizziness, chest pain or fainting | Chest pain, lightheadedness, breathlessness or syncope |
| Risk factors | Young, no heart disease, normal blood pressure | Older age, hypertension, diabetes, prior heart disease |
Related services we provide
Because palpitations may be an early sign of conditions that affect long term cardiovascular risk, we offer coordinated evaluation and care. That includes comprehensive preventive cardiology programs and targeted treatments for rhythm and risk reduction. Related services include Preventive Cardiology, Atrial Fibrillation Treatment, Cholesterol Management, Hypertension Management, and Stroke Prevention.
When arrhythmia diagnosis is uncertain, we use extended monitoring and interpretation tools described in our topic on Interpreting EKGs and advanced testing summaries such as Advanced Cardiac Testing to guide treatment choices.
Related locations we serve
We care for adults from throughout the greater New York metropolitan area, including Manhattan, the Bronx, Queens, Brooklyn, Westchester, Long Island and New Jersey. For information about our practice locations and directions see our locations and directions page.
Helpful external resources
Authoritative sources offer patient oriented information on palpitations and arrhythmias. Recommended reading includes the American Heart Association on irregular heartbeats, and the Mayo Clinic on palpitations. These resources explain basic mechanisms and first aid guidance for symptoms that require urgent attention.
For clinical guidance on anticoagulation decisions and stroke prevention, professional society statements summarize risk stratification and treatment options.
Key takeaway
Most palpitations are benign and related to lifestyle, stimulants or anxiety. Palpitations that are frequent, come with fainting, chest pain, dizziness or occur in people with heart disease need evaluation. We focus on accurate rhythm diagnosis and assessing long term cardiovascular risk so that treatment protects against stroke and heart complications while minimizing unnecessary interventions.
Frequently asked questions
What causes a feeling of skipped beats?
Skipped beats are often premature atrial or ventricular contractions. These extra beats briefly interrupt the normal rhythm and create the sensation of a skip or pause. When they are isolated and infrequent they are usually benign.
Can anxiety cause palpitations?
Yes. Anxiety and panic attacks commonly cause racing heart, sweating and shortness of breath. Treating anxiety, improving sleep and reducing stimulants often reduces these palpitations.
How is atrial fibrillation diagnosed when palpitations are intermittent?
Intermittent atrial fibrillation is identified with ambulatory monitoring. A 24 to 48 hour Holter monitor may catch frequent episodes, while event monitors or loop recorders can capture less frequent episodes over weeks to months.
Which tests check for heart structure problems that cause palpitations?
Echocardiography, commonly called an ultrasound of the heart, evaluates heart size, function and valve problems. When coronary disease is suspected, stress testing or coronary CT angiography can assess blood flow and blockages.
Should I stop caffeine if I have palpitations?
Reducing or avoiding caffeine and other stimulants is a reasonable first step. If palpitations persist despite lifestyle changes, further evaluation is sensible to rule out other causes.
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