Suddenly noticing your own heart — a thud, a "skipped" beat, a racing that starts out of nowhere — is one of the commonest reasons patients come to see me. And I understand why: any odd sensation in the chest sets alarm bells ringing. The good news: in most cases, palpitations hide nothing serious. The key is knowing when we can relax and when they deserve a proper work-up. That is what I want to talk about today.

What exactly are palpitations?

Palpitations are the conscious awareness of your own heartbeat. Normally the heart works without us noticing; when we suddenly feel it — faster, stronger, irregular or with pauses — we call that palpitations. Everyone describes them differently: "a flip in my chest", "as if my heart stopped for a second and then thumped", "a fluttering in my throat".

Let me be clear from the start: feeling your heart is not the same as having heart disease. But nor should we always dismiss palpitations: sometimes they are the first clue to an arrhythmia (a rhythm disturbance) that needs treatment.

The most common benign causes

Most of the palpitations I see in clinic have straightforward explanations:

Isolated ectopic beats (early beats that "sneak in" between the normal ones). Almost all of us have them; only some notice, especially at rest or lying in bed.
Coffee, tea, energy drinks and alcohol, which stimulate the heart and encourage extra beats.
Stress and anxiety: adrenaline speeds up the pulse and makes us far more aware of it.
Lack of sleep or poor-quality rest.
Fever and infections, which temporarily raise the heart rate.
Physical exercise: it is normal to feel your heart during and just after exertion.
Hormonal changes, such as those of pregnancy, the menstrual cycle or the menopause.

If they last a few seconds, settle on their own and come with no other symptoms, they are most likely harmless; many improve simply by adjusting coffee, alcohol, stress and sleep.

Red flags: when palpitations do need investigating

Sometimes palpitations stop being an anecdote and become a symptom to investigate. Please get checked if:

They come with significant dizziness or loss of consciousness (fainting).
They appear alongside chest pain or tightness, or breathlessness.
They start during exercise, rather than once you have finished.
They are fast, regular, and start and stop abruptly, like a switch flicking on and off.
There is a family history of sudden death or of inherited heart conditions.
You already have a known heart condition: a previous heart attack, a valve problem, heart failure...

None of these necessarily means something serious, but they do mean we should investigate. And an important point: if right now you have palpitations with chest pain, breathlessness or a blackout, do not wait for an appointment — call 112 or go straight to A&E.

Most palpitations are harmless, but every one of them deserves to be listened to: telling one from the other is precisely my job.

Atrial fibrillation: the arrhythmia we must not miss

Atrial fibrillation deserves a mention of its own: it is the most common sustained arrhythmia in adults. In it, the atria (the heart's upper chambers) beat in a disorganised way and the pulse becomes irregular and often fast. Its importance goes beyond symptoms: it raises the risk of stroke by encouraging clots to form inside the heart.

The tricky part: sometimes it causes no symptoms, or ones so vague they get put down to age or tiredness. So if you notice irregular palpitations — or a "chaotic" pulse picked up by chance, even by a smartwatch — it is worth confirming with an electrocardiogram. Catching it early lets us protect the brain and treat the arrhythmia: prevention in its purest form, which is how I like to work.

How we investigate palpitations in clinic

The work-up begins with the most valuable tool: listening to you. A good clinical history points to the diagnosis better than any test. Then, depending on the case, we use:

Electrocardiogram (ECG): an electrical "snapshot" of the heart at that moment.
24-48 hour Holter monitor: a continuous rhythm recording while you go about your normal life, useful when episodes are frequent.
Echocardiogram: an ultrasound scan that tells us whether the heart's structure and function are normal.
Longer event recorders, worn for one to several weeks, when episodes are sporadic and slip past the Holter.
Wearable devices (watches or wristbands with ECG): they do not replace medical tests, but can help us "catch" an episode.

What to note down before your appointment

You help me enormously by arriving with a small diary of your episodes:

When they happen: time of day, at rest or during activity.
How long they last: seconds, minutes, hours.
How they start and finish: abruptly or gradually.
What triggers them: coffee, alcohol, stress, lack of sleep, exercise...
If you can, take your pulse during an episode (fast? regular or irregular?) or save your watch's recording.

Your cardiologist's role: when to book an appointment

My role is to give your palpitations a proper name: to confirm whether an arrhythmia lies behind them, rule out a structural heart problem and, above all, give you back your peace of mind with real data. Very often the consultation ends with the best news: a healthy heart and a few simple lifestyle adjustments. Other times, an early diagnosis that makes all the difference.

If your palpitations keep returning, limit you, worry you or show any red flags, book an appointment and we will study them calmly; I see patients by appointment in Valencia and Dénia, in English as well as Spanish. Remember that my clinic is not an emergency service: with acute symptoms — chest pain, breathlessness, blackouts — always call 112. For everything else, you know my motto: the best medicine is good prevention, and listening in time to what your heart is trying to tell you is part of it.

Sources and further reading

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This article is for information only and does not replace individual assessment or advice from a healthcare professional. For acute symptoms such as severe chest pain, call 112.

Palpitations: when do they need investigating?