What Should I Do When I Feel Heart Palpitations? When Should I See a Doctor?

Heart palpitations are when a person feels their heartbeat differently than usual. This may be felt as the heart beating very fast, beating irregularly, or as "pounding," "skipping," or "fluttering like a bird's wings" in the chest. Palpitations are most often caused by temporary and harmless factors. However, in some cases they may be an early sign of an underlying rhythm disorder or heart disease.

What Causes Heart Palpitations?

Heart palpitations can occur for many different reasons. The most common are:

• Intense stress, anxiety, or panic
• Too much coffee, tea, energy drinks, or caffeine
• Smoking or nicotine use
• Alcohol use
• Lack of sleep and excessive fatigue
• Illnesses with fever
• Anemia (including iron deficiency)
• An overactive thyroid gland
• Certain cold or asthma medications
• Dehydration
• Intense physical activity
• Heart rhythm disorders

Brief palpitations that occur especially during periods of intense stress are usually not due to a serious illness. However, not every palpitation should be assumed to be harmless.

How Palpitation Frequency Relates to Age and Sex

Studies show that palpitations are more common in women than in men. There are several reasons for this:

• Women notice changes in their heartbeat more easily.
• Anxiety and panic are more common in women.
• Hormonal changes during periods such as pregnancy and menopause can increase palpitations.
• Conditions such as thyroid disease and anemia are more common in women.
• Especially in young and middle-aged women, a large proportion of palpitations stem not from a serious
• illness but from benign causes such as stress, anxiety, or the occasional "skipped beats" of the heart

. However, this does not mean that every palpitation is harmless.

The Risk of Rhythm Disorders Increases with Age

Most palpitations seen at a young age are usually harmless and occur for the following reasons:

• Stress and intense emotional states
• A faster heartbeat (in situations such as excitement, exertion, or fear)
• Occasional extra beats of the heart (a feeling of skipped beats)
• Lifestyle factors (lack of sleep, caffeine, smoking, etc.)

In older age, however, palpitations are more often associated with the following conditions:

• Irregular and fast heartbeat
• Attacks of sudden acceleration of the heart rhythm
• Disorders of the heart's conduction system
• Heart muscle or blood vessel diseases
• Therefore, new palpitations, especially in people aged 65 and over, should be taken more

seriously and should always be evaluated.

Who Needs More Attention?

Palpitations should be evaluated in more detail in the following people:

• People over 65
• People with known coronary artery disease
• People with heart failure
• Patients with hypertension or diabetes
• People with a family history of sudden cardiac death
• People who have palpitations together with fainting
• What Should I Do During Palpitations?

When you feel palpitations, first try to stay calm. Panicking can increase your heart rate even more. You can do the following:

1. Sit or lie down: If you feel dizzy, move into a safe position to reduce the risk

of falling.

2. Breathe deeply and slowly: Breathing in deeply through your nose and slowly out through your mouth

can help reduce stress-related palpitations.

3. Consider possible triggers

In the last few hours:

• Did you drink too much coffee?
• Did you have an energy drink?
• Did you go through a very stressful event?
• Did you not drink enough water?

These factors may explain the palpitations.

4. Check your pulse

If possible, count your pulse:

• Is it very fast?
• Is it regular?
• Or is it beating irregularly?

This information can be useful for your doctor's evaluation.

5. Write down your symptoms

Recording the following information helps with diagnosis:

• When did it start?
• How long did it last?
• What were you doing when it happened?
• Was it accompanied by dizziness, chest pain, or shortness of breath?

When Should I Get Emergency Help?

Some palpitations require emergency evaluation. If you have any of the following symptoms, call 112 (the emergency number in Turkey) or go to the nearest emergency department without delay:

• Chest pain or a feeling of pressure in the chest
• Shortness of breath
• Fainting or feeling like you are about to faint
• Severe dizziness
• Cold sweats
• Sudden confusion
• A very fast heartbeat that continues for minutes
• In people with known heart disease, new or markedly worsening
• palpitations
• These symptoms may be warning signs of serious rhythm disorders, a heart attack, or other significant cardiovascular

diseases.

When Should I See a Cardiologist?

Even if it is not an emergency, a cardiology evaluation is needed in the following situations:

• If palpitations recur frequently
• If they have increased markedly in recent months
• If each episode lasts longer than a few minutes
• If they occur during exercise
• If there is a family history of sudden death or serious rhythm disorders
• If you have hypertension, diabetes, or heart disease
• If the palpitations are accompanied by shortness of breath or weakness

What Can I Do to Prevent Palpitations?

• Sleep regularly.
• Avoid excessive caffeine.
• Do not smoke.

• Limit alcohol consumption.
• Drink enough fluids.

• Exercise regularly.

• Practice stress management techniques.
• Take the medications recommended by your doctor regularly.

In Summary

Although most heart palpitations stem from benign causes, they may be a sign of a serious rhythm disorder, especially when accompanied by chest pain, shortness of breath, dizziness, or fainting. Palpitations that recur frequently or impair quality of life should always be evaluated by a cardiologist.

References

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Wexler RK, Pleister A, Raman SV. Palpitations: Evaluation in the Primary Care Setting. Am Fam Physician. 2017. Gauer RL, Thomas MF, McNutt RA. Palpitations: Evaluation, Management, and Wearable Smart Devices. Am Fam Physician. 2024. Raviele A, et al. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace. 2011.Zimetbaum P, Josephson ME. Evaluation of Patients with Palpitations. N Engl J Med. 1998 May 7;338(19):1369-73. Weber BE, Kapoor WN. Evaluation and outcomes of patients with palpitations. Am J Med. 1996 Feb;100(2):138-48. Giada F, et al. Diagnostic management of patients with palpitations. G Ital Cardiol (Rome). 2010.

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