1
Breathe slowly and sit down
Sit or lie down and take slow, controlled breaths — in for a count of four, out for six. Calm, steady breathing settles the adrenaline that drives many benign palpitations.
Medically Reviewed By: Dr Paul Lim – MBBS, M.Med (Int Med), MRCP (UK), FAMS (Cardiology)
Heart Rhythm Symptom
Heart Palpitations (Fluttering, Pounding or Racing Heartbeat)
Heart palpitations are the feeling of being aware of your own heartbeat — a flutter, a pounding or thumping, a racing heart, or a skipped beat in the chest, throat, or neck. Palpitations are a symptom, not a diagnosis. Most are harmless and settle on their own, but some point to an underlying heart rhythm disorder — the only way to be sure is to record your heart’s rhythm while you feel them.
Dr Paul Lim Chun Yih
Senior Consultant Cardiologist & Electrophysiologist
22+
Years of
Clinical Experience
Clinical Experience
Your Heart Rhythm Specialist
Assessed by Dr Paul Lim
Senior Consultant Cardiologist & Cardiac Electrophysiologist
Dr Paul Lim subspecialises in heart rhythm disorders, investigating palpitations with ECG and prolonged heart monitoring, and treating the underlying arrhythmias with catheter ablation, pacemaker, and defibrillator implantation. He completed advanced fellowship training at Barts Heart Centre, London under Singapore’s HMDP award.
UK & SG
Fellowship Training
10,000+
Patient Consultations
1,000+
Ablation & Device Procedures
The Basics
What Are Heart Palpitations?
Heart palpitations are the sensation of feeling your own heartbeat. Normally you are not aware of your heart working, so when a beat feels stronger, faster, or out of step, you notice it. The medical meaning of a palpitation is simply this awareness of the heartbeat — it does not, by itself, say what is causing it.
People describe palpitations in many ways:
- Fluttering — a quivering or “butterflies” feeling in the chest
- Pounding or thumping — forceful beats you can feel in the chest or neck
- Racing — a sudden fast heartbeat
- Skipped or missed beats — a pause followed by a stronger beat, often from a harmless extra beat
- Flip-flopping — a brief tumbling sensation as the rhythm shifts
Normal rhythm
Steady, evenly spaced beats
A skipped beat
A pause, then a stronger beat you feel
The key point is that palpitations are a symptom, not a disease. Many are benign — caused by caffeine, stress, or poor sleep — and need no treatment. Others are the first sign of a treatable irregular heartbeat such as atrial fibrillation. Because the causes overlap and feel similar, a heart specialist aims to record your heart’s rhythm while you feel the palpitations — that recording is what turns a symptom into a diagnosis.
When you describe your palpitations, these details help narrow down the cause: whether the onset is sudden or gradual, whether the beat feels regular or irregular, how long each episode lasts, what you were doing when it started, and whether you have any other symptoms such as dizziness or breathlessness.
Red Flags
Are Heart Palpitations Dangerous? When Should You Worry?
This is the question patients ask most. The honest answer is that it depends on the accompanying symptoms and your overall heart health. Use the traffic-light guide below — in line with NHS advice — to decide what to do.
Emergency — Call 995 or go to A&E
Palpitations need emergency attention if you also have:
- Chest pain, tightness, or pressure
- Severe shortness of breath, especially at rest or when lying flat
- Fainting (syncope), near-fainting, or sudden confusion
- A very fast heartbeat that does not settle (for example, a resting pulse over 120) — or a very slow pulse together with fainting or breathlessness
- Signs of a stroke — sudden face drooping, arm weakness, or slurred speech (an irregular heartbeat can cause stroke)
- Collapse, or a seizure-like episode
Book a specialist appointment
See a cardiologist promptly if your palpitations are:
- Frequent, prolonged, or increasing over time
- Triggered by exercise or physical exertion
- Associated with dizziness, fatigue, or breathlessness
- Accompanied by near-fainting (even if you feel fine now)
- Accompanied by a persistently fast or unusually slow resting pulse
- Present alongside known heart disease, high blood pressure, or an inherited heart rhythm condition such as long QT syndrome or Wolff–Parkinson–White (WPW)
- Linked to a family history of sudden cardiac death or inherited heart conditions
- New-onset in mid-life or later, when arrhythmias such as atrial fibrillation become more common
Less likely to be serious — but still worth checking
These are less likely to indicate a serious rhythm problem, but see a doctor if you are unsure:
- A brief, single skipped or extra beat
- Palpitations triggered by caffeine, stress, or poor sleep that settle quickly
- No other symptoms such as dizziness, breathlessness, or fainting
Not sure which category you fall into? Speak to a cardiologist for a proper evaluation and peace of mind.
Worried about your palpitations? Get a professional assessment.
Why It Happens
What Causes Heart Palpitations?
Palpitations occur when the heartbeat becomes faster, stronger, or more irregular than usual — or when you simply become more aware of a normal beat. Some causes are everyday triggers; others point to an underlying condition. Often more than one factor is at play.
Note: this is not an exhaustive list. If you are experiencing symptoms, consult a doctor for a proper evaluation.
Heart rhythm causes
- Premature (extra) beats — harmless early beats (PACs and PVCs) are the most common cause of a “skipped beat” sensation
- Atrial fibrillation — a fast, irregular rhythm that raises stroke risk and needs treatment
- Supraventricular tachycardia (SVT) — sudden-onset rapid heart rhythms, often in otherwise healthy people
- Atrial flutter — a fast, organised rhythm from the upper chambers
- A very slow rhythm — some people feel forceful beats with bradycardia
Hormonal and medical causes
- Overactive thyroid — hyperthyroidism is a classic and easily tested cause
- Anaemia — low haemoglobin forces the heart to work harder
- Fever and infection
- Low blood sugar (hypoglycaemia)
- Electrolyte imbalance — low potassium or magnesium can trigger extra beats
- Hormonal changes — the menstrual cycle, pregnancy, perimenopause, and menopause
- Medication side effects — some asthma inhalers, decongestants, thyroid medication, and antidepressants
Lifestyle and trigger causes
- Caffeine — strong coffee, tea, energy drinks, and pre-workout supplements
- Stress and anxiety — adrenaline surges trigger palpitations, which then heighten anxiety — a common feedback loop
- Alcohol — particularly binge drinking (“holiday heart syndrome”)
- Poor sleep — even a single disrupted night can provoke palpitations
- Dehydration — a common trigger in Singapore’s climate
- Nicotine and recreational stimulants — smoking, and stimulants such as cocaine or amphetamines
- Large meals — especially late at night
- Exercise — palpitations brought on by exertion are a red flag that needs prompt evaluation
In many people, especially younger patients, no serious cause is found and the palpitations are benign extra beats. However, frequent premature beats can occasionally affect heart function over time, so a one-off specialist assessment is worthwhile so that you know exactly what you are dealing with.
In Context
Common Palpitation Scenarios
Palpitations often show up in particular situations. Here is what tends to be going on — and when each one is worth checking.
At night or when lying down
Palpitations frequently feel worse at night because there is less to distract you, and lying on your left side often makes the heartbeat more noticeable. A large or late meal, caffeine or alcohol earlier in the day, and anxiety all contribute. Night-time palpitations are usually benign, but those that repeatedly wake you from sleep — or come with breathlessness or chest discomfort — deserve an ECG and a check for causes such as atrial fibrillation or sleep apnoea.
After eating
Palpitations after eating are a commonly reported pattern, though the exact mechanism is not firmly established. Shifts in blood flow towards the digestive system and changes in the autonomic (“automatic”) nervous system as you digest are the usual explanation. Large meals, high-sugar or high-salt foods, caffeine, and alcohol are common triggers, and blood-sugar swings can play a part. Occasional palpitations after eating are generally harmless, but frequent or prolonged episodes are worth evaluating.
Anxiety and stress
Stress, anxiety, and panic release adrenaline, which speeds and strengthens the heartbeat. Because anxiety and a genuine arrhythmia can feel identical, palpitations should not be assumed to be “just anxiety” until a rhythm problem has been ruled out with an ECG. Once the heart has been checked and is healthy, that reassurance itself often helps break the palpitation–anxiety cycle.
Pregnancy
During pregnancy, blood volume rises by up to 50% and the heart works considerably harder, so palpitations are common and usually benign. They should still be mentioned at antenatal review, and any palpitations with fainting, chest pain, or significant breathlessness need prompt assessment. Simple tests — an ECG and blood tests for thyroid and haemoglobin — safely rule out causes that need treatment.
Perimenopause and menopause
Fluctuating hormone levels around menopause can make palpitations more noticeable, often alongside hot flushes and disturbed sleep. Most are harmless, but because thyroid problems and anaemia are also more common at this stage of life — and can cause the same symptom — a basic check with an ECG and blood tests is sensible.
Caffeine, alcohol, and stimulants
Caffeine, alcohol, nicotine, and stimulant supplements are among the most common everyday triggers. Cutting back is often an effective first step for benign palpitations. Keeping a short diary of what you consumed before an episode can reveal a clear pattern — and gives your specialist useful information at your consultation.
What It Feels Like
What Do Heart Palpitations Feel Like?
Palpitations vary from person to person. The sensation itself does not reliably reveal the cause — but the pattern, and any symptoms that come with it, help guide the assessment. An ECG recorded during an episode is what confirms the diagnosis.
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Fluttering A quivering or “butterflies” feeling in the chest — often described as the heart flip-flopping.
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Pounding or thumping Forceful beats you can feel in the chest, sometimes described as the heart “jumping”.
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Racing heartbeat A sudden fast heart rate, sometimes starting and stopping abruptly — typical of SVT.
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Skipped or missed beats A pause followed by a stronger beat — usually a harmless extra beat, and the most common palpitation.
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Neck or throat pounding A thumping or pounding felt in the neck or throat — most often linked to certain types of supraventricular tachycardia (SVT), and sometimes to premature ventricular contractions (PVCs).
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With dizziness, breathlessness, chest pain, or fainting Palpitations combined with any of these are a red flag — seek prompt or emergency assessment.
Talk to Dr Paul Lim for a proper diagnosis and peace of mind.
Self-Help
How to Stop or Calm Heart Palpitations
For an occasional, benign episode, these simple measures often help. They are not a substitute for evaluation — if palpitations are prolonged, or come with chest pain, severe breathlessness, dizziness, or fainting, stop and seek emergency care.
2
Stay hydrated
Dehydration is a common trigger, especially in Singapore’s heat. Drinking water at room temperature can help, and staying well hydrated through the day reduces episodes.
3
Try a vagal manoeuvre
If your heart suddenly starts racing, a “vagal” technique can sometimes slow it. The most effective is the modified Valsalva: bear down as if straining on the toilet for about 15 seconds, then lie back and have someone raise your legs. Splashing ice-cold water on the face can also help. Ask your doctor to show you the technique — and never press on your own neck, as carotid massage must only be done by a healthcare professional.
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Remove the trigger
Cut back on caffeine, alcohol, and nicotine, and prioritise sleep and stress management. Keep a short diary of what preceded each episode — it helps identify your personal triggers.
These steps help with benign, occasional palpitations. If palpitations keep returning, are getting more frequent, or interfere with daily life, book a consultation so the cause can be identified rather than just managed at home.
Symptom vs Diagnosis
Palpitations vs AFib, Arrhythmia & Tachycardia
These terms are often used interchangeably, but they are not the same thing.
Palpitations are the symptom — the feeling of your heartbeat. An irregular heartbeat (arrhythmia) is a diagnosis — an actual disturbance in the heart’s rhythm, which is one possible cause of palpitations. You can have palpitations without an arrhythmia (for example from caffeine or anxiety), and you can have an arrhythmia without feeling any palpitations at all.
The rhythm disorders most often responsible for palpitations include:
- Atrial fibrillation (AFib) — a fast, irregular rhythm that raises stroke risk; palpitations often feel chaotic and can last a while
- Tachycardia — a fast heart rate, including SVT, which typically starts and stops suddenly
- Atrial flutter — a fast, organised rhythm with a characteristic sawtooth ECG pattern
- Premature beats (PACs and PVCs) — harmless extra beats that cause the common “skipped beat” feeling
Because the same sensation can come from a completely benign cause or a treatable arrhythmia, the sensible approach is not to guess but to record the rhythm during an episode. That is exactly what the tests below are designed to do.
Getting a Diagnosis
How Heart Palpitations Are Diagnosed
The goal is simple: capture your heart’s rhythm while you feel the palpitations. Because palpitations come and go, diagnosis is a tiered approach that starts simple and escalates only if needed.
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1
Clinical history and examination
Dr Lim will ask what the palpitations feel like, how they start and stop, how long they last, their triggers, and any associated symptoms — then examine your pulse, blood pressure, and heart sounds.
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2
Electrocardiogram (ECG)
A quick 12-lead ECG records the heart’s electrical activity. It is diagnostic if captured during palpitations, and often reveals clues even between episodes.
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3
Holter monitor or event recorder
Because palpitations are usually intermittent, a Holter monitor worn from 24 hours to 14 days records your rhythm during normal daily life — the key test for catching palpitations in the act.
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4
Implantable loop recorder
For palpitations that are rare but significant, a small implantable loop recorder monitors the heart continuously for up to several years, so even infrequent episodes are captured.
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5
Echocardiogram and stress test
An echocardiogram checks the heart’s structure and pumping function. For palpitations brought on by exertion, a treadmill stress test reproduces the trigger under monitoring.
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6
Blood tests
Thyroid function, full blood count (for anaemia), and electrolytes (potassium and magnesium) identify common non-cardiac causes of palpitations that are simple to correct.
If a rhythm disorder is confirmed and treatment such as ablation is being considered, an electrophysiology study can pinpoint the exact source of the arrhythmia inside the heart.
Next Steps
When to See a Cardiologist for Palpitations
You do not need to live with uncertainty. A single specialist consultation — usually an ECG and, where needed, a Holter monitor — is often all it takes to find the cause of your palpitations or to confirm that your heart is healthy. Either outcome is worthwhile: treatment where it is needed, or genuine peace of mind where it is not.
It is especially worth booking a review if your palpitations are frequent, prolonged, triggered by exercise, associated with dizziness or breathlessness, or if you have known heart disease or a family history of sudden cardiac death. As a cardiac electrophysiologist, Dr Lim focuses specifically on heart rhythm problems and their treatment.
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Common Questions
Heart Palpitations FAQ
Answers to the most common questions about what heart palpitations feel like, what causes them, when to worry, and how they are diagnosed.
What do heart palpitations feel like?
Palpitations are an awareness of your own heartbeat. People describe them as a flutter, a pounding or thumping, a racing heart, a skipped or missed beat, or a brief flip-flop in the chest. The sensation can be felt in the chest, throat, or neck, and may last seconds or minutes. Feeling your heartbeat is not automatically a sign of disease — but if palpitations are frequent, prolonged, or come with dizziness, breathlessness, chest pain, or fainting, they should be assessed.
Are heart palpitations dangerous — when should I worry?
Most palpitations are harmless. Call 995 or go to A&E if they come with chest pain or pressure, severe shortness of breath, fainting or near-fainting, or weakness on one side of the body. Book a specialist appointment promptly if palpitations are frequent or prolonged, triggered by exercise, associated with dizziness or fatigue, or if you have known heart disease or a family history of sudden cardiac death. Brief single skipped beats that settle quickly are usually benign, but a one-off check gives peace of mind.
What causes heart palpitations at night or when lying down?
Palpitations often feel more noticeable at night because there is less background noise and activity to distract you, and lying on your left side often makes the heartbeat more noticeable. Common triggers include a large or late meal, caffeine or alcohol earlier in the day, anxiety, and poor sleep. They are frequently benign, but night-time palpitations that wake you from sleep, or come with breathlessness or chest discomfort, warrant an ECG and a review for causes such as atrial fibrillation or sleep apnoea.
Why do I get heart palpitations after eating?
Palpitations after eating are a commonly reported pattern, though the exact mechanism is not firmly established. Shifts in blood flow towards the digestive system and changes in the autonomic nervous system as you digest are the usual explanation. Large meals, high-sugar or high-salt foods, caffeine, and alcohol are common triggers, and blood sugar swings can also play a part. Occasional palpitations after eating are usually harmless, but if they are frequent, prolonged, or come with other symptoms, it is worth having them evaluated.
Can anxiety or stress cause heart palpitations?
Yes. Stress, anxiety, and panic release adrenaline, which speeds up and strengthens the heartbeat and can trigger palpitations and extra beats. Palpitations in turn heighten anxiety, creating a feedback loop that feels alarming but is usually harmless. Because anxiety and genuine arrhythmias can feel identical, it is still sensible to have an ECG to rule out an underlying rhythm problem before attributing palpitations to anxiety alone.
Are heart palpitations normal in pregnancy and menopause?
Palpitations are common in both. In pregnancy, blood volume rises by up to 50% and the heart works harder, so palpitations are frequently felt and are usually benign. During perimenopause and menopause, fluctuating hormones can make palpitations more noticeable. In both situations most palpitations are harmless, but they should still be mentioned to a doctor — an ECG and simple blood tests (including thyroid and haemoglobin) rule out causes that need treatment, and any palpitations with fainting, chest pain, or breathlessness need prompt review.
What is the difference between palpitations and atrial fibrillation (AFib)?
Palpitations are a symptom — the feeling of your heartbeat. Atrial fibrillation is one specific cause of that symptom: a fast, irregular rhythm from the upper chambers of the heart that raises the risk of stroke. Palpitations from AFib often feel chaotic and irregular and may last longer, but the only reliable way to tell the cause is to record the rhythm on an ECG or a Holter monitor during symptoms. Many people with palpitations do not have AFib, and some people with AFib feel no palpitations at all.
How do doctors test for heart palpitations?
The aim is to record your heart’s rhythm while you feel the palpitations. Assessment starts with a clinical history and a 12-lead ECG. Because palpitations come and go, a Holter monitor worn for 24 hours to 14 days is often used to catch them in daily life; for infrequent symptoms an implantable loop recorder can monitor for up to several years. An echocardiogram checks the heart’s structure, a treadmill stress test is used for exercise-related palpitations, and blood tests screen for thyroid problems, anaemia, and electrolyte imbalance.
Can a smartwatch detect heart palpitations?
A smartwatch or fitness band with a single-lead ECG (Apple Watch, Samsung Galaxy Watch, Fitbit, Garmin) can record your heart rate and rhythm during an episode and is useful for documenting when palpitations occur. It is a helpful screening aid, not a diagnosis — recordings can miss or misread rhythms. Save any recordings and the dates and times, and bring them to your consultation so they can be confirmed against a proper clinical ECG.
Can low magnesium or potassium cause heart palpitations?
Yes — low potassium or magnesium can disturb the heart’s electrical stability and trigger extra beats and palpitations, which is why electrolytes are checked with a simple blood test. Correcting a genuine deficiency, usually through diet or a doctor-guided supplement, can help. However, taking supplements without a confirmed deficiency is not an evidence-based treatment for palpitations and does not replace finding the underlying cause. Discuss any supplement with your doctor first.
How can I stop heart palpitations quickly?
For a benign episode, sit down, try slow, controlled breathing, and remove the trigger such as caffeine. A vagal manoeuvre can settle some fast, regular rhythms — the modified Valsalva (bearing down for about 15 seconds, then lying back with your legs raised) is the most effective, and splashing ice-cold water on the face can also help. Do not press on your own neck. These measures are for occasional, harmless palpitations only. If an episode is prolonged, or comes with chest pain, severe breathlessness, dizziness, or fainting, stop and seek emergency care rather than trying to manage it yourself.
Which doctor treats heart palpitations in Singapore?
Palpitations are assessed by a cardiologist, and specifically by a cardiac electrophysiologist when a heart rhythm disorder is suspected. Dr Paul Lim is a Senior Consultant Cardiologist and Electrophysiologist in Singapore who subspecialises in heart rhythm disorders, with clinics at Orchard and Jurong. A consultation typically includes an ECG and, where needed, a Holter monitor to capture the palpitations and identify the cause.