Palpitations are an awareness of one’s own heartbeat that is noticeable and often uncomfortable. People describe palpitations in different ways: a fluttering or flipping sensation in the chest, a racing or pounding heartbeat, a feeling of the heart skipping or pausing, or an unusually forceful beat. Palpitations may be felt in the chest, throat, or neck, and can last seconds or minutes.
Palpitations are extremely common in the general population and have many causes, most of which are benign. Common causes include caffeine, alcohol, stress and anxiety, vigorous exercise, dehydration, tiredness, and medication side effects. In these cases the palpitation reflects a normal variation in heart rhythm, such as an ectopic beat (a beat that fires slightly early and is followed by a compensatory pause), and poses no risk to health.
However, palpitations can also be a symptom of a cardiac arrhythmia that requires investigation. Relevant arrhythmias include atrial fibrillation, supraventricular tachycardia (SVT), atrial flutter, ventricular tachycardia, and ventricular ectopic beats. Palpitations accompanied by dizziness, blackout, chest pain, or breathlessness warrant urgent medical assessment.
After a cardiac arrest, palpitations can be particularly distressing. Survivors often develop heightened awareness of their heartbeat as part of health anxiety or PTSD, interpreting normal cardiac sensations as signs of imminent danger. For people with an ICD, a palpitation may raise fear of an impending shock. It is important that survivors discuss any new or concerning palpitations with their cardiologist or cardiac nurse, both to rule out arrhythmia and to obtain reassurance where appropriate. Keeping a brief symptom diary noting timing, duration, and triggers can be helpful for clinical assessment.
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