Cardiology Made Clearwith Dr. Freeman
All diagnoses

PATIENT EDUCATION · PALPITATIONS

Palpitations

Understand racing, fluttering, or skipped beats, possible causes, testing, and next steps.

Section 2 of 6 · Possible causes

← Palpitations: the short explanation
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All 6 sections, including text and pictures · 16 pages

What should I do now?

Call 911

Call 911 for new or unexplained chest pressure that persists or returns, severe trouble breathing, collapse without normal recovery, or sudden face/arm weakness or trouble speaking. Do not drive yourself.

Contact your care team

Contact your care team for new, longer, or more frequent episodes, or reduced activity.

Keep your care plan

Record timing, duration, and symptoms when safe; save any available EKG recording.

Patient summaries & logs →

SECTION 2

What can cause palpitations?

Palpitations have many possible causes. They may come from extra beats, an abnormal rhythm, or a normal heartbeat responding to something happening in your body.

1. Extra beats or abnormal heart rhythms

Palpitations may come from early beats or an abnormal heart rhythm. These examples show how different rhythms can look on an EKG.

PAC — premature atrial contraction

Regular sinus beats interrupted by an early atrial beat with a different P wave and a narrow QRS complex.
An early beat starts in an upper chamber. It may feel like a skip, flutter, or thump.
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PVC — premature ventricular contraction

Regular sinus beats interrupted by a premature wide ventricular beat followed by a pause.
An early beat starts in a lower chamber. The early beat and the pause afterward may feel like a skipped beat followed by a stronger thump.
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SVT — supraventricular tachycardia

Fast regular rhythm with narrow QRS complexes.
A fast rhythm that often starts and stops suddenly. This example shows a regular, rapid heartbeat.
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Atrial fibrillation — AFib

Uneven spacing between QRS complexes, a fibrillatory baseline and no consistent P waves.
The heartbeat is irregular. There is no consistent pattern of normal upper-chamber electrical waves.
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Atrial flutter

Continuous sawtooth flutter waves with regular QRS complexes in an example of two-to-one conduction.
This typical flutter example shows repeated flutter waves between beats. Flutter can produce a regular or irregular pulse.
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Ventricular tachycardia — VT

Rapid regular rhythm with wide ventricular complexes.
A fast rhythm starts in a lower chamber. This rhythm requires prompt medical assessment.
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How the heartbeat feels does not reliably identify the rhythm. Recording it during symptoms helps determine the cause.

Illustrative examples, not patient recordings. Each strip represents approximately six seconds; display size is not calibrated. Actual EKGs vary and require clinical interpretation.

2. Everyday triggers

Some people notice palpitations with:

  • Stress or anxiety
  • Exercise
  • Caffeine or energy drinks
  • Alcohol
  • Nicotine
  • Dehydration

Triggers vary from person to person. Keeping a record of when symptoms happen can help identify a pattern.

3. Other medical conditions

Examples include:

  • Anemia: Too few healthy red blood cells.
  • Thyroid problems: Especially an overactive thyroid.
  • Fever or illness.
  • Low blood sugar.
  • Electrolyte abnormalities: Changes in minerals such as potassium.
  • Hormonal changes during pregnancy or menopause.

4. Medications and supplements

Some cold medicines, inhalers, stimulant medications, and supplements can cause palpitations.

Bring a complete list of prescription medicines, over-the-counter products, and supplements to your appointment. Discuss any changes with your clinician before stopping a prescribed medication.

Could it just be anxiety?

Anxiety can cause palpitations, and palpitations can make you feel anxious. Both may occur together.

New or recurring symptoms should be evaluated rather than automatically attributed to anxiety. Identifying the cause helps us choose the right treatment.

Sources & further readingNIH: Rhythm testingNIH: Arrhythmia treatmentMayo Clinic: Palpitations and warning signsMayo Clinic: Evaluation and appointment preparation

Updated October 2026. Educational information; your own care plan may differ. Medical illustrations are simplified examples for teaching.