People of all ages experience heart palpitations, described as an awareness of your heart beating in your chest. ‘Some people describe feeling their heart racing, beating very strongly or pounding, or skipping a beat. Others describe a fluttering sensation in their chest. Sometimes this experience lasts for only a few seconds or it may go on for hours,’ says Lead GP at Livi, Dr Rhianna McClymont.
Palpitations are non-specific, meaning they can be a symptom or a diagnosis. ‘There are a variety of causes of heart palpitations,’ Dr McClymont explains. ‘Many causes are harmless, and most palpitations aren’t a sign of anything sinister.’
There are a number of different causes of palpitations, including:
Lifestyle factors are a common trigger. Some people notice palpitations after drinking alcohol.
Caffeine and nicotine can also cause palpitations, particularly when used excessively, as can other recreational drugs, explains Dr McClymont. If you experience heart palpitations after eating, it might be a result of eating very sugary foods, drinking energy drinks or overeating.
While exercise can trigger palpitations as a result of the heart needing to pump faster to send oxygenated blood to the muscles, Dr McClymont stresses that regular exercise is important for a healthy heart.
‘We can experience palpitations if we’re under significant stress or experiencing a strong emotion,’ says Dr McClymont, adding that anxiety disorders and panic attacks in particular are also linked to heart palpitations. In fact, studies have shown anxiety and other psychosomatic triggers are responsible for around a third of all cases of heart palpitations.
Most causes of palpitations actually have nothing to do with your activity levels. It’s not uncommon to notice palpitations more at night when you’re trying to sleep, says Dr McClymont. ‘It’s a time when it’s quiet and your mind isn’t as distracted by other tasks.
‘Lying down on your left side may make palpitations more noticeable, as in this position your heart is right next to your chest wall.’
Heart palpitations are one of the common symptoms of long Covid, and several studies have confirmed that the Covid-19 virus gains access to the heart and can cause abnormal structural changes as well as inflammation.
‘A number of people suffering from long Covid have reported palpitations,’ says Dr McClymont. ‘It’s known that many people who were hospitalised with severe Covid symptoms suffered damage and inflammation to the heart muscle, but it’s also clear that people who had relatively mild symptoms of Covid-19 have developed a range of symptoms afterwards, collectively known as long Covid.
‘There’s so much that we still don’t know about long Covid in terms of prognosis, severity and duration of symptoms, but research is ongoing.’
‘Thyroid problems – particularly an over-active thyroid – are a common cause of heart palpitations,’ says Dr McClymont. ‘Other associated conditions include anaemia, low blood pressure, dehydration and sepsis.’
Anaemia, she explains, causes increased work for the heart as there are fewer red blood cells in the body and these carry the oxygen. ‘This means the heart has to pump more quickly to push the existing red blood cells around the body faster to deliver enough oxygen,’ says Dr McClymont. ‘This extra work on the heart can lead to palpitations.
‘Conditions affecting the heart – such as heart failure, valve disorders, cardiomyopathy and problems with the electrical conduction in the heart – could also be the cause.’
Very occasionally, heart palpitations can be a symptom of a serious heart condition, including certain types of structural heart disease. If there’s no obvious explanation for your symptoms and the palpitations don’t go away, you should make an appointment to see a doctor.
‘Being pregnant means that your heart needs to pump more blood around your body to supply the growing baby and placenta. This causes your heart rate to increase – which, in some cases, can lead to palpitations,’ Dr McClymont confirms.
Palpitations are quite common during pregnancy and usually not a sign of anything serious. However, if it does turn out that the palpitations are a symptom of heart rhythm disturbances that need to be managed, most treatments are perfectly safe in pregnancy.
‘If you drink alcohol or caffeine regularly, cutting back can often reduce the frequency of palpitations or stop them altogether,’ Dr McClymont recommends. ‘It’s recommended that we drink no more than 14 units of alcohol per week, and it’s best to space out these drinks throughout the week. Binge-drinking is more likely to lead to palpitations.’
Think about your stress or anxiety triggers, too. If you suffer from anxiety, your heart rate can go up as a result of what’s known as ‘fight or flight’ mode, which can trigger palpitations. Talk to a doctor if you’re struggling, as there are things you can do to cope and manage your symptoms.
‘If you have heart palpitations accompanied by chest pain, dizziness or severe shortness of breath or you faint or collapse, you should seek emergency help from your nearest A&E department as it could be a sign of a serious problem with your heart,’ says Dr McClymont.
‘If you have recurrent palpitations that have been going on for a while and haven’t improved with simple lifestyle changes, speak to a doctor, who can arrange further tests.’
Dr Rhianna McClymont
Lead GP at Livi