A common myth says that if you can feel your heart beating, something must be wrong with it. In reality, most people feel their heartbeat now and then: after a third cup of coffee, during a tense meeting, or lying on their left side in a quiet bedroom.
Heart palpitations are usually caused by everyday triggers such as caffeine, nicotine, stress, anxiety, exercise, fever, some medicines, or hormone changes, and most are harmless. Less often, they point to a thyroid problem, anemia, or a heart rhythm disorder, so new or frequent palpitations deserve a checkup, and palpitations with chest pain, fainting, or shortness of breath need emergency care.
MedlinePlus describes palpitations as feelings or sensations that your heart is pounding or racing, or that it is skipping or adding a beat. You might feel it in your chest, throat, or neck. Noticing them doesn’t mean your heart is failing. It means you’re paying attention, which is useful.
What heart palpitations can feel like
People describe palpitations in very different ways, and the description can help your doctor:
- Pounding: a strong, heavy beat you can feel without touching your chest.
- Racing: a fast beat, sometimes starting and stopping suddenly.
- Fluttering: a quivering or “butterflies” feeling in the chest.
- Flip-flop or skipped beat: a pause followed by a hard thump. This is often an extra early beat, which is common.
Everyday palpitation triggers
MedlinePlus and the National Heart, Lung, and Blood Institute (NHLBI) list a range of common, often harmless causes.
Caffeine, nicotine, and alcohol
Coffee, energy drinks, strong tea, and some sodas contain caffeine, which can make your heart beat faster or harder. Nicotine from cigarettes or vaping has a similar effect. Alcohol can also trigger palpitations in some people, sometimes the morning after drinking.
Stress, anxiety, and fear
The body’s stress response speeds up your heart. Panic attacks can cause a pounding heart along with shortness of breath and a sense of dread. Palpitations from anxiety are real, not “in your head”, but it’s still wise to have new symptoms checked before assuming that’s the cause.
Exercise and fever
Your heart is supposed to beat faster when you work out or run a fever. You may notice it more as it slows back down.
Medicines and other substances
MedlinePlus lists some medicines that can cause palpitations, including certain decongestants, some asthma inhalers, thyroid medicine, and diet pills. Illegal drugs such as cocaine and amphetamines can cause dangerous rhythms. Don’t stop a prescribed medicine on your own. Ask your doctor or pharmacist whether a new medicine might be the reason.
Hormone changes
Shifts in hormones during your period, pregnancy, or perimenopause and menopause can bring on palpitations. During pregnancy, the heart also works harder to pump extra blood, so a faster heartbeat is common. Mention it at your next prenatal visit, and call sooner if it comes with shortness of breath or dizziness.
When palpitations come from a medical condition
Sometimes the trigger is inside the body rather than in your cup. Conditions that can cause palpitations include:
| Possible cause | Other clues that may show up | How it’s usually checked |
|---|---|---|
| Overactive thyroid | Weight loss, feeling hot, shaky hands, trouble sleeping | Blood test |
| Anemia (low red blood cells) | Tiredness, pale skin, shortness of breath with activity | Blood test |
| Low blood sugar | Shakiness, sweating, hunger, confusion | Blood sugar check |
| Heart rhythm problem (arrhythmia) | Racing that starts and stops suddenly, fluttering, dizziness | ECG, heart monitor |
| Atrial fibrillation | Irregular heartbeat, tiredness, breathlessness, or no symptoms | ECG, heart monitor |
| Heart disease or valve problems | Chest discomfort, swelling in the legs, getting winded easily | ECG, echocardiogram |
If an irregular, fluttering rhythm sounds familiar, our guide to AFib symptoms explains that condition and why it matters for stroke risk.
Your palpitation diary
Palpitations rarely show up during a doctor’s visit. A diary bridges that gap. Keep it for two weeks, or until you’ve logged five episodes.
| Date and time | What it felt like | How long it lasted | What you were doing | Caffeine, alcohol, or nicotine in the last few hours | Other symptoms | Pulse, if you checked |
|---|---|---|---|---|---|---|
| Tue, 10:40 p.m. | Fluttering, then a hard thump | About 30 seconds | Lying in bed on left side | 2 coffees, last one at 3 p.m. | None | Felt regular after |
Tips for getting the most out of it:
- Try to tap out the rhythm on a table. Steady and fast, or irregular? Doctors find this surprisingly helpful.
- Check your pulse during an episode if you can. Our guide to normal resting heart rate shows how.
- Note your period or pregnancy week if that applies.
- Write down every medicine and supplement you take, including cold remedies.
How doctors check heart palpitations
Your doctor will ask about your symptoms, listen to your heart, and review your medicines. Common next steps include:
- Electrocardiogram (ECG or EKG). Small stickers on your chest record your heart’s electrical activity for a few minutes. It’s quick and painless.
- Blood tests to look for thyroid problems, anemia, or low potassium or other mineral imbalances.
- A portable heart monitor if the palpitations come and go. NHLBI describes monitors you wear for a day or two (a Holter monitor) and others you wear for weeks that record when you have symptoms.
- An echocardiogram, an ultrasound of the heart, if your doctor wants to see its structure and valves.
If the tests are normal, that’s genuinely good information. Many people find their palpitations bother them less once they know the heart itself is healthy.
Easing palpitations that come from everyday triggers
Once a doctor has ruled out a medical cause, these steps may help:
- Cut back on caffeine gradually, and stop it by early afternoon if palpitations show up at night.
- Stop smoking or vaping. Ask your doctor about support to quit.
- Limit alcohol, especially if your diary links it to episodes.
- Make room for calm: slow breathing, regular exercise, and enough sleep can lower the stress load on your heart.
- Stay hydrated and eat regular meals, especially if you feel shaky when you skip food.
Palpitations that need care now
Call 911 if palpitations come with any of these:
- Chest pain, pressure, or tightness
- Shortness of breath
- Fainting or nearly fainting
- Confusion or loss of alertness
- Unusual sweating
- Sudden weakness or numbness, trouble speaking, or a drooping face (see our guide to signs of a stroke)
Call your doctor soon if palpitations are new or more frequent, last a long time, feel irregular, or if you have heart disease, high blood pressure, diabetes, or a family history of sudden heart problems.
Start the palpitation diary tonight
Copy the diary into your phone’s notes app before bed, and fill in the first row the next time you feel your heart flutter. In two weeks you’ll likely see a pattern, or you’ll have exactly what your doctor needs to look for one.
If your episodes feel irregular rather than just fast, read our guide to AFib symptoms next.
