Palpitations – What Could Be Causing Them?

Palpitations are a very common symptom that most people experience at least once in their lifetime.They can feel like your heart is beating fast, irregularly, skipping a beat - or suddenly pounding harder than usual.

Most of the time, this is completely harmless. But in some cases, palpitations can be a sign of an underlying heart rhythm disorder that should be evaluated by a doctor.

How Are Palpitations Evaluated?

When you see a doctor for palpitations, the most important test is an ECG (electrocardiogram). An ECG taken during an episode of palpitations can show what type of rhythm disturbance is present.

An ultrasound of the heart (echocardiogram) is often recommended to check that the heart is structurally normal and functioning properly. Even if the ECG isn’t recorded during an episode, it can still provide valuable information.

If both the ECG and ultrasound are normal, the likelihood of a serious cause is quite low.

When a More Thorough Evaluation May Be Needed

Further testing is considered if you have:

• A history of heart disease (such as previous heart attack or heart failure)

• Higher age

• A family history of inherited heart disease

• Sudden unexplained death in close relatives

• Additional symptoms such as dizziness, shortness of breath, fainting, or feeling clammy and unwell

  
  

In such cases, your doctor may recommend other test which may include long-term rhythm monitoring or a stress test (exercise ECG) to assess how your heart behaves under physical strain.

Common Causes of Palpitations

1. Extra Beats – The Harmless “Skipped Beats”

Most people have extra beats from time to time, often without noticing them.

• Premature atrial complexes (PACs): These extra beats start in the upper chambers (atria) of the heart. They are harmless but can feel like your heart “skips” or “flutters.”Common triggers include stress, excessive caffeine, alcohol, and lack of sleep.

PAC - almost always harmless. A very common phenomenon.

• Premature ventricular complexes (PVCs):T hese start in the lower chambers (ventricles).They often feel like a strong beat after a short pause. Many healthy people have a few of these each day. However, if you experience frequent PVCs, an echocardiogram is recommended to rule out heart disease.

PVS are also very common in healthy adults. However frequent PVCs may require clinical assessment

2. Fast Rhythm from the Upper Chambers – Supraventricular Tachycardia (SVT)

These rhythm disturbances appear suddenly and often stop on their own. They can last from a few minutes to several hours and feel like a rapid but regular heartbeat. Recording an ECG during the episode is essential for diagnosis.

Tip: You can sometimes stop an SVT episode yourself using the Valsalva maneuver – gently trying to blow air out against a closed nose and mouth (like when you equalize ear pressure on a plane).

SVT er common among both young and elderly. ECG under ongoing SVT is critical for correct diagnosis as there are different types of SVTs, and treatment is different for different types of SVTs.

3. Atrial Fibrillation – The Irregular Rhythm

Atrial fibrillation (AF) is a very common heart rhythm disorder, especially in older adults - but it can also occur in younger people. It causes an irregular and often chaotic heartbeat, sometimes described as a “fluttering” or “racing” sensation.

AF is more common in people with high blood pressure, diabetes, obesity, or those who have done intense endurance training for many years.

It’s important that this diagnosis is confirmed by a specialist, since treatment often involves blood-thinning medication, which requires careful consideration.

AF - irregular fast heart rythm

4. Rhythm Disturbances from the Lower Chambers

These are less common and usually occur in people with underlying heart disease. Generally, these forms can be serious and require urgent medical attention. Here ECG and echocardiogram are key to making the distinction.

Ventricualr tachycardia - almost always require further clinical assessment.

5. Slow Heart Rhythm

In some individuals, especially older people, the heart’s electrical system can work too slowly. This may cause symptoms such as palpitations, dizziness, or fainting. In certain cases, a pacemaker may be needed.

It’s important not to confuse this with extra beats - using medications like beta-blockers in these cases can make the rhythm even slower.

AV-block might have same symptoms as PVCs og PACs

6. Palpitations Without Any Rhythm Disturbance

In many people, especially the young, palpitations occur even though the heart rhythm is completely normal. This can be related to stress, anxiety, hormones, excessive caffeine, alcohol, or lack of sleep - and is not dangerous.

In Summary

Palpitations are very common, and most often harmless – but they should be evaluated by a doctor if:

• The episodes are frequent or prolonged

• You have known heart disease or a family history of sudden death

• You experience dizziness, shortness of breath, fainting, or feel clammy and unwell during the episodes

  
  

ECG, medical history, and echocardiogram are the cornerstones of evaluation. With these tests, your doctor can almost always determine the cause - and provide reassurance and the right follow-up.