Usually benign, occasionally not — and the distinguishing features are reasonably clear.
Assessed by a GMC-registered GP, not a symptom checker
Honest about what needs to be seen in person
Tests and referrals arranged where they are needed
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Call 999 for palpitations with chest pain, severe breathlessness, fainting, or collapse.
Seek same-day assessment for:
Arrange assessment for palpitations that are becoming more frequent, last longer than a few minutes, or come with dizziness.
Palpitations means being aware of your own heartbeat — racing, thumping, fluttering, or a sensation of a missed or extra beat. Everyone's heart occasionally does this, and most people simply do not notice.
The vast majority are harmless ectopic beats. But a minority represent an arrhythmia worth finding, and the features that separate them are reasonably consistent — which is why the history matters more than reassurance.
Benign and very common — ectopic beats, felt as a skip followed by a thump. Often more noticeable lying in bed or after caffeine, alcohol or a poor night's sleep.
Driven by something else
Arrhythmias worth identifying — atrial fibrillation, which is irregular and raises stroke risk substantially but is very treatable; SVT, which starts and stops abruptly with a very fast regular rate.
Palpitations are notoriously difficult to diagnose because they have almost always stopped by the time anyone can check. What changes that is a recording made during an episode.
If you have been told your episodes are a supraventricular tachycardia, these vagal manoeuvres often terminate them:
Do not press on your neck or eyeballs — both are unsafe, and both still circulate as advice.
Call 999 if palpitations come with chest pain, severe breathlessness, or if you faint or nearly faint. Fainting during palpitations, or fainting with no warning at all, is the combination that most needs urgent attention.
Take your anticoagulant exactly as prescribed — it is preventing a stroke, and missing doses is the point at which that protection lapses. Palpitations returning is worth reporting, but the anticoagulant matters more than the rhythm.
The history does most of the work: whether the rhythm is regular or irregular, how it starts and stops, how long it lasts, and what brings it on. Tapping the rhythm out during the consultation is genuinely informative.
We arrange thyroid function and full blood count as a matter of course, since thyroid disease and anaemia between them explain a large share of cases and both are easily fixed.
What we cannot do is record your heart rhythm. Where the picture suggests an arrhythmia, an ECG or a longer recording is needed, and we arrange it. A consumer smartwatch ECG is imperfect but genuinely useful — if yours has captured an episode, bring it.
Record it while it is happening. Palpitations nearly always stop before anyone can examine you, which is why they so often go undiagnosed for years. If your watch or phone can take an ECG, use it during an episode and save the trace. Otherwise, count your pulse for a full minute and note whether it is regular or irregular — that single detail narrows things considerably.
Three things change the picture: fainting or nearly fainting, chest pain, or severe breathlessness during an episode. Also concerning: palpitations brought on by exercise, an episode lasting hours, or a family history of sudden cardiac death under 40. Any of those needs urgent assessment rather than reassurance.
Often it is — but the order of reasoning matters. Anxiety and abnormal heart rhythms feel very similar, and anxiety does not protect you from arrhythmia. It is also common for a genuine arrhythmia to cause anxiety, which then gets treated as the primary problem. A recording during an episode settles it; assumption does not.
Not diagnose — but it can be genuinely valuable. Watch ECGs are not diagnostic on their own and produce false alarms, yet a saved trace from during an episode is real evidence and has led to a great many AF diagnoses that would otherwise have been missed. Bring the traces; do not rely on the label the watch gives them.
Quite possibly, and it is simple to check. An overactive thyroid is a common and easily missed cause of palpitations, particularly with weight loss, tremor, heat intolerance, anxiety or loose stools. Anaemia is the other frequently overlooked cause. Both are a straightforward blood test.
Very common, and usually reassuring. Lying still and quiet simply makes you aware of a heartbeat you would not otherwise notice, and lying on your left side puts the heart closer to the chest wall. Nocturnal palpitations that wake you from sleep, or come with breathlessness, are a different matter and worth reporting.
Yes — more reliably than most people realise. Binge drinking is a well-recognised trigger for atrial fibrillation, often the day after rather than during. Caffeine, energy drinks, pre-workout supplements and decongestants are the other common provocateurs, and cutting them is worth a genuine trial before anything else.
Better than you might expect, because the diagnosis here comes largely from the history and from any recording you have made. We can arrange thyroid function, a full blood count and other tests, and refer for a 24-hour or longer monitor — which is what actually catches an intermittent rhythm. What we cannot do is examine you or record an ECG ourselves, so anything with fainting, chest pain or exertional symptoms goes for urgent in-person assessment.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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