If you’ve ever suddenly felt like your heart missed a beat, or beat erratically for a few seconds, you’ve likely had a heart palpitation. These common occurrences can cause a fluttering or pounding sensation in the chest, and you may also feel breathless. Heart palpitations can be quite startling, but experts say these sensations have a variety of causes, many of which are harmless. Palpitations can occur when you’re physically active or when you’re just sitting around—even when you’re sleeping. And while anyone can have them, there are times when a person is more likely to experience them. What are some common causes of heart palpitations?

  • Caffeine. Do you feel that fluttering or those extra beats shortly after your morning cup of joe? There may be a connection: The stimulant (energizing) effect of caffeine not only wakes you up but may also cause your heart to briefly beat irregularly. Try drinking a mix of half regular and half decaf coffee, or switch to decaf and see if your palpitations cease. You also may experience palpitations after drinking soda or energy drinks or eating chocolate, all of which contain caffeine.
  • Nicotine. Add heart palpitations to the long list of smoking’s undesirable side effects.
  • Anxiety. It makes sense that feeling stressed can make your heart feel like it has flip-flopped—after all, fear and anxiety can make it beat faster and harder for a more prolonged period. Practice deep breathing to calm yourself, and avoid situations that tend to make you anxious.
  • Medications. Many drugs, both legal and illegal, can act as stimulants and cause irregular heartbeats. Common culprits include cold medicines, blood pressure drugs, amphetamines, asthma inhalers, and diet pills. “In addition, some over-the-counter medications as well as herbal/nutritional supplements may interact with your prescription medications and bring on palpitations,” says John P. Higgins, MD, MPH, MPHIL, associate professor of medicine at The University of Texas Medical School and chief of cardiology at Lyndon B. Johnson General Hospital, both in Houston. Be sure you check the labels for side effects and interactions, and speak to your doctor about your concerns.
  • Illness. If you’re running a fever or are dehydrated (lack fluids in the body), you may experience more palpitations than normal. Chronic medical conditions such as a hyperactive thyroid or anemia can trigger them as well.
  • Exercise. Upping your heart rate may cause a palpitation or two. Take it down a notch if the sensation is upsetting or if the palpitations continue. Higgins recommends staying well hydrated, since dehydration itself can cause palpitations.
  • Hormonal fluctuations. When progesterone levels rise and estrogen levels fall, it can cause an increase in irregular heartbeats. Women may notice a definite increase in palpitations during the premenopausal and menopausal years, as well as during pregnancy and just before menstruation.
  • Electrolyte imbalance. If your electrolytes (substances like salt, calcium, and potassium in the body) are either too high or too low, your heart muscle may become irritated and you may experience palpitations. Vomiting and/or diarrhea, both of which can deplete electrolytes, may cause them also.

While most of the time heart palpitations don’t pose any danger, in some cases they may signal an underlying heart problem. Palpitations that are coupled with dizziness, breathing difficulties, or fainting definitely are cause for concern. If you experience these symptoms, a cardiologist likely will order tests including an electrocardiogram, a 24-hour Holter monitor, blood lab tests, a stress test, and an echocardiogram in order to make a diagnosis.

Reviewed by John P. Higgins, MD, MBA, MPHIL,The University of Texas Medical School and chief of cardiology at Lyndon B. Johnson General Hospital, Houston.


"Women and Abnormal Heart Beats." The Cleveland Clinic. Accessed April 29, 2014. http://my.clevelandclinic.org/heart/disorders/electric/women-abnormal-heart-beats.aspx

"Heart Palpitations." National Institutes of Health. Accessed April 29, 2014. http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm