When to worry about heart palpitations: Signs that require medical attention

Palpitations can feel like a fluttering or racing heart, or like your heart is skipping a beat. Most of the time, they’re not dangerous. But if they happen often, last a long time or come with dizziness or chest pain, it’s important to see a doctor.

Heart palpitations are feelings that the heart is skipping beats, fluttering or racing.

Most of the time, they’re not dangerous. Heart palpitations may happen because of stress, caffeine or exercise. But sometimes, palpitations can be a sign of a serious heart problem that needs medical care.

Knowing when to worry about heart palpitations and when to see a doctor can help prevent future health problems.

What are heart palpitations?

Heart palpitations are unusual feelings in the chest that come from changes in the heartbeat. They can feel different for each person.¹

People often describe them as feelings of¹:

• Racing
• Fluttering
• Pounding
• Thumping
• Skipped heartbeat
• Irregular heartbeat
• Beating too hard or too fast

These sensations can happen while sitting still, lying down or during activity. They might feel scary, but they usually aren’t anything to worry about.¹

Many factors can cause palpitations, like¹:

• Stress
• Anxiety
• Caffeine
• Alcohol
• Tobacco
• Some medicines, like decongestants
• Illegal drugs, like cocaine
• Dehydration
• Intense exercise
• Panic attacks
• Medical conditions, like thyroid disease and anemia

When should someone be concerned about palpitations?

Most heart palpitations are harmless. But some symptoms can be serious.

It’s important to see a doctor if palpitations happen with any of these symptoms¹:

• Chest pain
• Dizziness or lightheadedness
• Shortness of breath
• Gasping during sleep
• Confusion
• Fainting
• Feeling very tired or weak
• Palpitations that happen often or last a long time

If you have heart disease, high blood pressure or other risk factors, it’s important to take extra caution. Seeing a provider early can help find problems like arrhythmia before they lead to serious complications.

Arrhythmias happen when the heart’s electrical signals don’t work right. This can make your heart beat too fast, too slow or in an uneven pattern. The most common type of arrhythmia is atrial fibrillation, which affects over 5 million people in the United States.^2,3

In atrial fibrillation, the upper and lower chambers of the heart don’t beat in sync, and the heart can’t pump blood efficiently. Without medical attention, arrhythmia can lead to serious problems like stroke or heart failure.^2,3

What is the evaluation like for heart palpitations?

A doctor will ask about lifestyle, medications, family history and details about the palpitations. They may ask when they started, how long they last and what triggers them.

A doctor then does a physical exam. This may include:

• Checking for swelling in the legs and feet
• Feeling the pulse and measuring the heart rate
• Listening to the heart

After the physical exam, your doctor may want you to have tests done. Common tests used to evaluate heart palpitations include:⁴

• Electrocardiogram (ECG or EKG): A simple, painless test that records the electrical activity of the heart to look for rhythm problems.
• Heart monitors: These are portable devices that record heart activity for a few days or weeks during usual activities.
• Blood tests: Blood tests may be used to check for thyroid problems, electrolyte imbalances or other conditions that can affect heart rhythm.
• Echocardiogram: An echocardiogram uses ultrasound to look at the structure and function of the heart.
• Cardiac MRI: A cardiac MRI is a noninvasive test that uses magnets, radio waves and a computer to produce clear images of the heart.
• Stress tests: Stress tests monitor heart activity during physical exertion. They may reveal exercise-induced arrhythmias.

Your doctor may refer you to a cardiologist for more testing or specialized care. A cardiologist is a doctor who specializes in heart health.

What treatments are available for palpitations and other heart rhythm issues?

Treatment depends on the cause of palpitations. Often, simple lifestyle changes are enough. These may include¹:

• Cutting back on alcohol (if you drink) and caffeine
• Not smoking (if you smoke)
• Managing stress with relaxation or therapy
• Drinking enough water
• Eating a balanced diet low in salt and unhealthy fats
• Staying away from medicines that can make the heart race

For heart rhythm conditions, a cardiologist may prescribe medicines. In serious cases, you might need a medical procedure. These can include:

• Pacemakers or implantable cardioverter defibrillators (ICDs): An ICD is a small device placed in the chest that keeps the heart beating properly.
• Electrical cardioversion: This is a controlled shock that resets the heart.

Treating other health problems, like thyroid disease or anemia, can also lower palpitations.

Takeaway

Most heart palpitations are harmless, but some can signal serious heart problems. Symptoms like chest pain, dizziness, shortness of breath, fainting or palpitations that happen often should be checked by a doctor.

Knowing the warning signs of heart rhythm problems can help keep the heart healthy and prevent serious complications in the future. Seeking care early gives the best chance for proper treatment and peace of mind.

1. American Academy of Family Physicians. Heart palpitations. 2023.
2. American Heart Association. What is atrial fibrillation? 2025.
3. National Heart, Lung, and Blood Institute. Arrhythmias. 2022.
4. National Heart, Lung, and Blood Institute. Heart tests. 2022.