Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down:


Many things can trigger palpitations, including:

  • Strong emotions
  • Vigorous physical activity
  • Medicines such as diet pills and decongestants
  • Caffeine, alcohol, nicotine, and illegal drugs
  • Certain medical conditions, such as thyroid disease or anemia (a low blood count).

These factors may make the heart beat faster or stronger than usual, or they cause occasional extra heartbeats. In these situations, the heart is still working normally, and the palpitations usually are harmless.

Sometimes palpitations are symptoms of an arrhythmia. An arrhythmia is a problem with the rate or rhythm of the heartbeat.

Some arrhythmias are signs of heart conditions, such as heart attack, heart failure, heart valve problems, or heart muscle problems. However, less than half of the people who have palpitations have arrhythmias.

People can reduce or prevent palpitations by avoiding things that trigger them (such as stress and stimulants) and treating related medical conditions.


Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can determine whether you need treatment or ongoing care.

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How Are Palpitations Diagnosed?

Your doctor will first want to find out whether your palpitations are harmless or related to a more serious heart problem. To do this, he or she will ask about your symptoms and medical history, do a physical exam, and recommend several basic tests.

This information may point to a heart problem as the cause of your palpitations. If so, your doctor may recommend more tests. These will help show what the problem is and how to treat it.

The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.

Specialists Involved

Several types of doctors may work with you to diagnose and treat your palpitations. These include a:

  • Primary care doctor
  • Cardiologist (a doctor who specializes in diagnosing and treating heart diseases and conditions)
  • Electrophysiologist (a cardiologist who specializes in the heart's electrical system)

Medical History

Your doctor will ask questions about your palpitations, such as:

  • When did they begin?
  • How long do they last?
  • How often do they occur?
  • Do they start and stop suddenly?
  • Does your heartbeat feel steady or irregular during the palpitations?
  • What other symptoms do you have when you get palpitations
  • Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?

Your doctor also will ask you about your use of caffeine, alcohol, supplements, and illegal drugs.

Physical Exam

Your doctor will take your pulse to find out how fast your heart is beating and whether it's beating with a normal rhythm. He or she also will use a stethoscope to listen to your heartbeat.

Your doctor may look for signs of other conditions (such as an overactive thyroid) that can cause palpitations.

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Diagnostic Tests

Often, the first test that's done is an EKG. This simple test records your heart's electrical activity.

An EKG is used to detect and locate the source of heart problems. It shows how fast your heart is beating and whether its rhythm is steady or irregular. It records the strength and timing of electrical signals as they pass through each part of your heart.

Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart's structure, function, and electrical system.

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Holter or Event Monitor

A Holter monitor is a small device that records your heart rhythm. You usually wear a Holter monitor for one to three days, and during that time, the device will record all of your heartbeats. A Holter monitor test is usually performed after a traditional test to check your heart rhythm (EKG) isn't able to give your doctor enough information about your heart's condition.

A Holter monitor has electrodes that are attached to your chest with adhesive and connected to a recording device. Your doctor uses information captured on the Holter monitor's recording device to figure out if you have a heart rhythm problem.

While wearing a Holter monitor may be a little inconvenient, it's an important test that may help your doctor diagnose your condition.

Reasons why a Holter monitor test is done include:

  • Observe for cardiac irregularities, such as fast or slow heartbeat, extra beats or palpitations
  • Evaluate effectiveness of cardiac medications
  • Evaluate pacemaker functioning
  • Determine if unexplained episodes of dizziness are related to heart problems

Once your monitoring period is over, you'll go back to your doctor's office to return the Holter monitor.

You'll also turn in the diary you kept while you wore the Holter monitor. When the Holter monitor is interpreted, your doctor will compare the data from the recorder and the activities and symptoms you wrote down. If your heart rhythm changed while you completed strenuous activities or experienced symptoms, knowing that information can help your doctor diagnose your condition.

After your doctor has looked at the results of the Holter monitor recorder and what you've written in your activity diary, he or she will talk to you about your results. The information from the Holter monitor may reveal that you have a heart condition, or your doctor may need more tests to find out what may be causing your symptoms.

In some cases, your doctor may not be able to diagnose your condition based on the results of the Holter monitor test, especially if you didn't have any irregular heart rhythms while you wore the monitor. Your doctor may then recommend an event recorder. You wear an event monitor as much as possible throughout the day, and push a button on a recording device you wear on your belt to record your heartbeat when you experience symptoms.

Holter Monitor

Figure A shows how a Holter monitor attaches to a patient. In this example, the monitor is clipped to the patient's belt and electrodes are attached to his chest. Figure B shows an electrocardiogram strip, which maps the data from the Holter or event monitor.

Who Needs a Holter or Event Monitor?

Your doctor may recommend a Holter or event monitor if he or she suspects you have an arrhythmia. An arrhythmia is a problem with the rate or rhythm of the heartbeat.

Holter and event monitors most often are used to detect arrhythmias in people who have:

  • Fainted or sometimes feel dizzy. A monitor may be used if causes other than a heart rhythm problem have been ruled out.
  • Palpitations that recur with no known cause. Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast. You may have these feelings in your chest, throat, or neck.

People who are being treated for heart rhythm problems also may need to use Holter or event monitors. The monitors can show how treatments are working.

Heart rhythm problems may only occur at certain times, such as during sleep or physical exertion. Holter and event monitors record your heart rhythm while you do your normal daily routine. This allows your doctor to see how your heart responds to different daily activities, which can help diagnose the problem.

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Echocardiogram (Echo; TransThoracic Echocardiogram; TTE)

An echocardiogram is a specialized ultrasound machine that creates a video image of the beating heart. This non-invasive test is often used to identify problems with heart muscle and valves.It is a fast, easy and painless evaluation that uses ultrasound waves to produce images of the heart, evaluate your heart’s performance as well as the inside, including the heart chambers and valves. An echo may sometimes also be used to look for the cause of a heart murmur, to check the size of the heart chambers, for fluid around the heart, or to inspect the pumping capability of the heart if a patient is short of breath or has other symptoms, f.i. during exertion.

Another type of echocardiogram is a transesophageal echocardiogram also referred as a TEE.  This test may be recommended to evaluate different structures in the heart such a valves or blood clots.  The esophagus sits behind the heart and by advancing the echo transducer down the esophagus common obstructions are avoided such as the lungs and ribs.  This provides clearer images.  

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