Here’s what actually happens when your heart skips a beat

By Chase Alston | Feb. 24, 2021 Medically reviewed by Anis Rehman, MD

When you hear the term heart palpitations, it sounds serious—but in reality, they are something many people experience every day. They are that flutter you feel in your chest when your crush walks by. Or, the sensation of your heart stopping for just a moment when you get bad news. They can even be the racing, sweaty feeling you have after taking a dose of Sudafed. What causes heart palpitations? There are many things that bring them about. Here’s how to know when that feeling is benign, or a sign of something more serious.

What are heart palpitations?

Palpitations describe a commonly felt sensation that your heart is fluttering, pounding, flip-flopping, racing, or skipping a beat. They generally describe a situation when your awareness of your own heartbeat is heightened for one reason or another.

While heart palpitations can be unsettling, when they occur infrequently, they are not usually a sign of heart disease. “Almost everyone feels them from time to time,” says Leonard Pianko, MD, cardiologist at Aventura Cardiovascular Center. “Most of the time heart palpitations are benign.”

In fact, “they’re pretty common among all age groups,” says Fahmi Farah, MD, cardiologist at Baylor Scott & White Health and Bentley Heart. “A lot of people in their 20s all the way to people of more advanced age like 65 and up can all get palpitations.”

What causes heart palpitations?

Heart palpitations have many potential causes. Below are some of the common, mostly harmless explanations for heart palpitations:

Emotions: Phrases like “died of a broken heart” and “scared to death” aren’t purely colloquial. Several studies have tied anxiety, stress, panic attacks, and other strong emotional experiences to irregular heart rhythm, such as palpitations. When you feel a strong emotion, your body releases hormones that affect your heartbeat. “With the COVID-19 pandemic, anxiety is a really big contributor to increases in heart palpitations,” Dr. Farah explains.
Vigorous activity: When you exercise, your heart rate and cardiac output (the amount of blood circulating in your body each minute) increase significantly. That can cause palpitations in otherwise healthy people—especially if you haven’t worked out in a long time.
Hormone changes: Varying hormone levels during menstruation, pregnancy, and just prior to menopause can trigger heart abnormalities. Overactive thyroid disorders, such as Graves’ disease or a toxic thyroid nodule, can lead to palpitations. A rare adrenal disease called pheochromocytoma increases stress hormones, which results in palpitations and chest pain.
Stimulants: Nicotine, cocaine, amphetamines, and other stimulants can all cause changes in heart rate. The degree of impact varies from person to person. While many heart palpitations have historically been attributed to caffeine, a recent study from the Journal of the American Heart Association debunks this connection. In healthy individuals, even excess caffeine is unlikely to cause significant changes in heart rhythm.
Low blood pressure: Fluctuations in blood pressure can happen for many reasons, such as changes in body position or diet. When your blood pressure drops down, one of the ways your heart compensates is by increasing heart rate to help keep blood flow stable throughout the body. This rise in beats can cause a heart flutter.
Medications: Medications used to treat asthma, high blood pressure, and even over-the-counter decongestants can cause heart palpitations depending on the person.
Low blood sugar: When you’re very hungry, you may start to feel weak, sweaty, or like your heart is racing. This type of palpitation is triggered by adrenaline, a hormone your body releases to prepare for a food shortage.
Fever: When your body temperature is high, you are using energy faster than normal. This can affect your heart rate.
Alcohol: Overindulging in adult beverages may make your heart beat faster, giving you that fluttering feeling.
Certain medical conditions: Thyroid problems, hypertension, and valvular heart disease are just some of the medical conditions which can promote palpitations, according to Dr. Pianko.

If you have heart palpitations occasionally for one of these reasons, it’s usually not a major health issue.

Are heart palpitations serious?

Most heart palpitations aren’t cause for concern. But, there are instances when that fluttering feeling is a sign of something more serious. They can be caused by cardiac arrhythmia—a group of heart conditions that make the heart beat too slowly or too quickly. The most common types include:

Atrial fibrillation or AFib (erratic, irregular heartbeat)
Bradycardia (slow heartbeat)
Supraventricular tachycardia (rapid heartbeat that starts in the upper chambers above the ventricles)

Distinguishing between benign and serious palpitations

Regularly occurring heart palpitations may be due to an artery blockage or some form of cardiovascular disease. To determine the cause of your heart flutters, your healthcare provider may refer you to a cardiologist for additional tests, such as:

Echocardiogram to see if the heart walls and valves are working as they should be
Stress test to see how heart function and breathing are impacted by exertion
Electrocardiogram (ECG or EKG) to identify abnormal heart rhythms
A Holter monitor—a portable ECG device that continuously records heart rhythms for 24 to 48 hours

Be sure to seek medical attention or call 911 if you’re experiencing any of the following symptoms in addition to palpitations:

Chest pain/tightness
Shortness of breath or difficulty breathing
Dizziness or lightheadedness
Confusion
Loss of consciousness

These may be signs of cardiac arrest, which can be life-threatening.

How to stop health palpitations

Before discussing treatment, your healthcare provider will need to know your history: how long you have had palpitations, how long they last for, whether there are certain movements or circumstances that cause them—along with any underlying health conditions. “Palpitations may signify something different in someone with anemia versus someone with underlying lung disease versus someone with structural heart disease or heart failure,” says Nupoor Narula, MD, assistant professor of medicine in cardiology at Weill Cornell Medical College.

For milder cases of heart fluttering, lifestyle adjustments help to decrease the frequency, or help to slow a racing heartbeat. For more severe, frequent palpitations medication or a surgical procedure may be required.

Lifestyle changes

Start by taking note of what triggers your heart palpitations. Then, take steps to reduce your exposure to that stimulus. Some of these techniques include:

Practice yoga or meditation: One of the most common sources of heart palpitations is anxiety. Yoga and meditation can help manage stress, which may alleviate heart fluttering.
Learn deep breathing techniques: Breathing rate and heart rate are often tied together. Using box breathing (four seconds breathing in, four seconds holding, four seconds breathing out, four seconds holding) can regulate breath and heart rate, reducing palpitations.
Limit caffeine intake: While caffeine may not universally cause heart fluttering, each person has varying sensitivities. It may be helpful to minimize your coffee consumption while trying to stop heart fluttering.
Quit smoking: Stopping smoking reduces your nicotine exposure, a substance that can trigger heart palpitations.
Eat regularly: Following a healthy diet, and consuming regular meals can stop spikes and drops in your blood sugar that could cause heart palpitations.

If alcohol or an over-the-counter medication triggers your palpitations, work with your healthcare provider to make a plan to avoid that substance.

Medications

In instances where lifestyle changes are not enough, two types of medications are often used for heart palpitations: beta blockers and centrally acting calcium-channel blockers. These both help to slow and regulate your heartbeat.

If an underlying condition is causing your heart palpitations, the treatment will involve treating that condition. For example, you may be prescribed Ativan to help manage anxiety. Or, you may go home with a prescription for an overactive thyroid (hyperthyroidism).

Procedures

In less common instances, heart palpitations may not respond to lifestyle modifications or medications. Procedures such as a catheter ablation, pacemaker, or implantable defibrillator may be needed.

Not all heart palpitations have an exact cause, and many do not require medical treatment. Though they can feel stressful, let your healthcare provider reassure you that what you’re experiencing is most likely not dangerous. Just reassess your symptoms regularly, and reach out if there are any changes.