My heart is racing or skipping
Palpitations are the feeling that your heart is racing, pounding, fluttering, or skipping a beat. Most are not dangerous. The goal is to catch what your heart is doing while you feel it.
From Dr. Kenny Civello, cardiologist and electrophysiologist
Chest pain, trouble breathing, fainting, or feeling like you are about to faint. Do not drive yourself.
If you feel fine otherwise
A record made during the feeling helps more than anything else you can bring us.
Sit down
Stop what you are doing and rest. Lightheadedness can come on fast.
Record it
If you have a watch or pocket device with an ECG, record one now. See how to record a useful ECG. If not, count your pulse for 30 seconds and double it.
Write it down
Note the time, how long it lasted, what you were doing, and whether the beat felt steady or uneven. Did it start and stop all at once, or build and fade?
Tell us
Bring your notes and tracings to a visit. Call the office sooner if the items below apply to you.
Your palpitations are new and keep coming back. They start during exercise. They last more than a few minutes. You have heart disease or a heart device. Someone in your family died suddenly at a young age.
What it might be
How it feels gives clues. Only a tracing can say for sure.
Extra beats
A skip, a thump, or a pause. An early beat comes, then a short rest, then a stronger beat that you feel. These are common and usually harmless.
Normal fast rate
Your heart speeds up and slows down gradually. Stress, fever, low fluids, anemia, and an overactive thyroid can all do this.
SVT
A fast, steady racing that starts and stops all at once, like a switch. You may feel it in your neck. It is treatable. More on fast rates.
AFib
An uneven, often fast beat with no pattern. AFib can raise your risk of stroke, so it matters to find it. How AFib is treated.
POTS
A racing heart that comes on when you stand up and eases when you lie down. Living with POTS.
Ventricular rhythms
Fast rhythms from the lower heart chambers are less common and can be serious, mostly in people with heart disease. This is why exercise symptoms and fainting need a closer look.
Common triggers
Your notes may show a pattern. Look at what happened in the hours before.
- Alcohol, nicotine, energy drinks, and stimulant drugs
- Cold medicines with decongestants
- Asthma inhalers, thyroid pills, and stimulant medicines for ADHD
- Poor sleep, stress, illness, and not drinking enough fluids
Do not stop a prescribed medicine on your own. Ask us first.
Do I have to give up coffee?
Often, no. In a 2023 trial, people had more extra beats from the lower chambers on coffee days. Extra beats from the upper chambers did not clearly change. If coffee sets yours off, cut back. If it does not, you may not need to give it up.
What happens at your visit
We start simple and add tests only if we need them.
Your story and an ECG
We go over how it feels, your medicines, and your family history. An ECG looks for clues, even when you feel fine.
Blood tests
We may check for anemia, thyroid problems, and low potassium or magnesium.
A heart monitor
If the ECG was normal, a monitor can catch the rhythm. You wear a patch for days to weeks. The choice depends on how often it happens.
A heart ultrasound
We may look at the heart's structure if we suspect heart disease or find a rhythm problem.
Treatment depends on the cause. Harmless extra beats often need only a plan for your triggers. Rhythm problems may need medicine or an ablation.
Common questions
My watch ECG was normal. Am I in the clear?
Only for that moment. An ECG shows your rhythm while you record it. If you recorded after the feeling passed, it cannot tell us what happened. A watch ECG also does not check for every rhythm problem. If you do not own a device, a pocket ECG is one way to catch symptoms that come and go.
Could it just be anxiety?
Anxiety can cause palpitations. A rhythm problem can also cause anxiety. We check your heart first so nobody blames stress for a rhythm we can treat.
Can I stop an episode myself?
Extra beats usually pass on their own. If you have a diagnosed rhythm like SVT, ask us whether a breathing and bearing down maneuver is right for you. Do not try new moves during an episode with chest pain or faintness. Call 911.
This page is general education for my patients. It does not replace advice from your own doctor.
Based on: Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024. Page RL, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. J Am Coll Cardiol. 2016. Al-Khatib SM, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Am Coll Cardiol. 2018. Raviele A, et al. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace. 2011. Gauer RL, et al. Palpitations: evaluation, management, and wearable smart devices. Am Fam Physician. 2024. Marcus GM, et al. Acute effects of coffee consumption on health among ambulatory adults. N Engl J Med. 2023.