First, decide if you need urgent help
Call 999 or go to A&E if you currently have palpitations that do not go away, or you also have chest pain, shortness of breath, feel faint or faint. If these symptoms have stopped, ask for an urgent GP appointment, call NHS 111 or use 111 online. Do not drive yourself to A&E.[1]
What palpitations can feel like
You may notice racing, pounding, fluttering, skipped or extra beats. You may feel the sensation in your chest, neck or throat. Episodes can last seconds, minutes or longer. The sensation does not identify the cause on its own, so describe the pattern and any accompanying symptoms when you seek advice.[1] [2]
Possible causes and triggers
Palpitations have many possible causes, and more than one factor may be present. The NHS and NICE list the examples below. Only an individual assessment can determine what is contributing in your case.[1] [2]
| Group | Examples to discuss |
|---|---|
| Everyday triggers | Exercise, lack of sleep, stress, alcohol, caffeine, nicotine, recreational drugs and some medicines can trigger palpitations. |
| Hormonal or physical changes | Pregnancy and menopause can be associated with palpitations. Fever or dehydration can also affect how your heartbeat feels. |
| Conditions outside the heart | Iron-deficiency anaemia and an overactive thyroid are among the conditions a clinician may consider, depending on your symptoms and assessment. |
| Heart-related causes | An arrhythmia or another heart condition can be associated with palpitations. Symptoms alone cannot identify the cause or type of rhythm. |
When to arrange an assessment
Arrange a GP assessment if palpitations keep coming back, become more frequent, last longer than a few minutes, or you have a heart condition or family history of heart problems. NICE also recommends considering associated symptoms, triggers, medical and family history, medicines and lifestyle factors during assessment.[1] [2]
A short symptom record can help. Note when episodes happen, how long they last, what you were doing, the sensation you felt, any symptoms that occurred with it, medicines or substances taken, and relevant family history. This record supports assessment; it cannot diagnose a rhythm.
Tests that may be used
A clinician selects investigations after taking a history and examining you. NICE says a 12-lead ECG should ideally be arranged during symptoms where possible. It also describes ambulatory ECG monitoring, blood tests and echocardiography as tests that may be considered according to the clinical findings.[2]
| Assessment or test | Role | Important limit |
|---|---|---|
| Clinical assessment | Questions about onset, duration, frequency, triggers, associated symptoms, medical and family history, medicines and lifestyle factors. | Helps a clinician decide whether and how urgently further assessment is needed. |
| 12-lead ECG | A recording of the heart’s electrical activity, ideally during an episode of palpitations when possible. | May identify rhythm features present at the time. A result needs clinical interpretation. |
| Ambulatory ECG monitoring | A longer recording period selected by a clinician when symptoms are intermittent or further rhythm information is needed. | May help correlate a recorded rhythm with symptoms. It does not guarantee that an episode will be captured. |
| Echocardiogram | An ultrasound test that assesses heart structure and function. | May be considered if assessment suggests structural heart disease. It does not record an intermittent heart rhythm. |
| Blood tests | Tests may help assess possible contributors such as thyroid problems or anaemia when clinically indicated. | Results are interpreted alongside the history, examination and any heart tests. |
How the tests differ
An ECG records electrical activity. An echocardiogram assesses structure and function. A Holter monitor records ECG information over a longer period. One test does not replace the others; the most appropriate route depends on the question raised by your assessment.
If you are booking a private appointment
The clinic can confirm the suitable appointment route, availability, referral requirements, preparation, reporting and follow-up arrangements at booking. A private appointment does not replace emergency care. Use urgent NHS routes if you have the emergency symptoms described above.
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Frequently asked questions
Are heart palpitations always serious?
No. The NHS says palpitations are common and usually harmless, but they can have several causes. You should seek assessment if they keep returning, are becoming more frequent, last longer than a few minutes, or you have a heart condition or a family history of heart problems.
Can stress or caffeine cause palpitations?
They can be triggers. The NHS lists stress, lack of sleep, caffeine, alcohol, nicotine, exercise and some medicines among common causes. A trigger does not confirm the cause of your own symptoms, particularly if they recur or you have other symptoms.
Will an ECG tell me why I have palpitations?
An ECG can provide useful information about electrical activity and rhythm when it is recorded. NICE advises arranging a 12-lead ECG ideally during an episode. A clinician decides how to interpret the result and whether another test is appropriate.
Do I need a Holter monitor?
A clinician may consider ambulatory ECG monitoring when palpitations have an uncertain cause or are intermittent. The type and duration of monitoring should match the clinical question and how often symptoms occur.
Can blood tests help?
Blood tests may be used to investigate possible contributors such as an overactive thyroid or anaemia when indicated. They are one part of an assessment, not a stand-alone explanation for palpitations.
References
- [1] NHS. Heart palpitations. Last reviewed 17 March 2026. Accessed 30 August 2026. View source
- [2] NICE Clinical Knowledge Summaries. Palpitations. Last revised February 2026. Accessed 30 August 2026. View source
- [3] British Heart Foundation. Heart palpitations. Updated 6 October 2025. Accessed 30 August 2026. View source