Heart Palpitations: Causes, Diagnosis & Monitoring Irregular Heartbeats
Introduction
Heart palpitations are the sensation of feeling your own heartbeat – often described as a fluttering, racing, or pounding in the chest. They can sometimes even be felt in the throat or neck. For many people, palpitations are brief and harmless. Yet, if you’re experiencing them frequently or intensely, it’s natural to worry about an irregular heartbeat. In this article, we’ll explain what causes heart palpitations, why they can be hard to catch on a standard ECG, and how modern long-term heart monitors (like the Zio patch) are proving to be the best heart monitors for palpitations. Our goal is to provide clear, authoritative information in a warm, reassuring tone – so you know when to seek help and how to take charge of your heart health.
What Are Heart Palpitations?
Palpitations are essentially a heightened awareness of your heartbeat. Your heart might feel like it’s skipping beats or fluttering, or like it suddenly starts racing or thumping harder than usual. You might notice this unusual heartbeat sensation in your chest, or even up into your throat and neck. In most cases, the heart’s actual rhythm can be perfectly normal during a palpitation episode – it’s just that you’re feeling it more. Palpitations can last for just a few seconds or for minutes at a time. They often start and stop suddenly.
It’s important to know that palpitations are very common, and by themselves they are usually not dangerous. Almost everyone will experience this sensation at some point. Anything that makes your heart beat faster or irregularly can trigger palpitations – and many everyday things can cause those changes. Let’s look at some of the common causes and also the more serious causes of palpitations.
Palpitations at Night – Why Do They Feel Worse?
Many people report that their palpitations feel more noticeable at night when they’re lying in bed. If you’ve ever had palpitations at night, you’re not alone. One reason is that at night there are fewer distractions – it’s quiet and you’re still – so you become more aware of your heartbeat. Skipped beats or a racing heart that you might not notice in the daytime can feel much more pronounced when you’re trying to sleep. Sometimes simply lying on your side or pressing on the mattress can make you feel your pulse stronger in your chest.
In addition, certain triggers often happen in the evening or nighttime: for example, having a late heavy meal, drinking alcohol in the evening, or stress after a long day can provoke palpitations. If you find your heart is pounding at night, it’s worth looking at common culprits like caffeine or alcohol intake, stress levels, and even dream-related adrenaline surges. The good news is that night-time palpitations are usually still benign – but because they can disturb your sleep and peace of mind, you should mention them to your doctor. They may suggest monitoring your heart rhythm during the night to put your mind at ease.
What Causes Heart Palpitations?
Heart palpitations can have many causes, ranging from completely benign lifestyle factors to underlying medical conditions. Most often, palpitations are triggered by something outside of a serious heart problem. Common benign causes include:
- Stress and anxiety: Emotional stress, panic attacks, or even just a sudden scare can release adrenaline that makes the heart race.
- Strenuous exercise: It’s normal to feel your heart pounding after you exercise hard.
- Stimulants: Caffeine (coffee, tea, energy drinks), nicotine (smoking), and even some cold medications or diet pills can cause palpitations. Recreational drugs and heavy alcohol use are also frequent triggers.
- Lack of sleep or fatigue: Not getting enough rest can predispose you to palpitations. Ever notice your heart feels “flip-floppy” after a sleepless night? Fatigue and dehydration can play a role.
- Hormonal changes: Many people experience palpitations during menopause, pregnancy or even with menstrual cycles. These are usually temporary and related to shifts in hormones or blood flow.
- Fever or illness: A high fever or infection can make your heart beat faster as your body fights it off.
In most of these situations, the palpitations are not a sign of heart damage – they’re a normal response of the body, or “false alarms” caused by harmless extra beats. For example, stress or caffeine can trigger extra heartbeats called ectopic beats, which feel like a skipped or strong beat. Though unsettling, in a healthy heart these ectopic beats are usually benign.
However, sometimes palpitations do signal an underlying health issue. Less common causes of palpitations include medical conditions such as an overactive thyroid gland (hyperthyroidism) or low blood count (anaemia). Both of those conditions rev up the heart rate. Low blood pressure can also cause a racing heart as your body tries to compensate.
Importantly, palpitations can be a symptom of a heart rhythm disorder (arrhythmia). There are many types of arrhythmias, and a few common ones include:
- Atrial fibrillation (AFib): an irregular, often rapid heartbeat arising from the heart’s upper chambers. AFib is a leading cause of palpitations in people over 40 and becomes more common with age. It can cause a fast, chaotic pulse and sometimes dizziness or breathlessness, though some people have no symptoms at all. AFib is not immediately life-threatening, but it does increase stroke risk if untreated, so it’s important to detect.
- Supraventricular tachycardia (SVT): a broad term for fast heart rhythms that start above the lower chambers. SVT episodes can make the heart suddenly race or pound (often over 150 beats per minute) and then stop as abruptly as they started. These episodes can cause palpitations and lightheadedness, but are usually not dangerous in a structurally normal heart. They can often be treated or cured if necessary (for example, with a procedure called ablation).
- Ventricular arrhythmias: these are abnormal rhythms starting in the heart’s lower chambers. Ventricular tachycardia is one example that may cause a very fast pulse, often in people with existing heart disease. This type can be serious or even life-threatening, especially if it degenerates into ventricular fibrillation. Fortunately, such dangerous arrhythmias are rare in healthy individuals – they typically occur in the context of other heart problems (like after a heart attack or with cardiomyopathy).
Finally, structural heart diseases (like damaged heart valves or heart muscle weakness) can lead to palpitations as well. For instance, if you have a leaky valve or heart failure, you might feel palpitations along with other symptoms.
The bottom line on causes: The vast majority of palpitations in an otherwise healthy person are due to benign causes – either lifestyle factors or minor arrhythmias that aren’t dangerous. However, because a few palpitations can be due to more serious conditions, it’s wise to pay attention to the context and discuss with a healthcare professional if you’re concerned. Next, we’ll discuss how doctors figure out what’s causing palpitations and why it isn’t always straightforward.
Diagnosing an Irregular Heartbeat (Why Palpitations Can Be Hard to Catch)
If you visit a doctor complaining of palpitations, one of the first tests they’ll do is a standard electrocardiogram (ECG or EKG). This is a quick test that records the electrical activity of your heart for 10 seconds or so. An ECG can show if your heart rhythm is normal at that moment, or if there are obvious arrhythmias. If you happen to be in an arrhythmia while the ECG is running, it’s fantastic – the doctor can see it and identify it immediately.
However, palpitations don’t always occur on cue during a doctor’s visit. In fact, it’s pretty common that by the time you get hooked up to the ECG, your heart is beating normally again. A normal resting ECG does not necessarily mean your heart rhythm is always normal – it only means nothing was off during that short recording. As the Cleveland Clinic notes, an EKG only measures your heart’s activity at that moment in time, while your symptoms may come and go at other times. Inconveniently, the heart can flip into an arrhythmia and then back to normal between doctor visits.
So what can be done if your ECG in the clinic looks normal, but you know you felt something irregular at home? This is where longer-term heart rhythm monitoring comes in. Doctors have a few tools to “capture” an intermittent irregular heartbeat:
- Holter monitor: This is basically a portable ECG device you wear continuously, typically for 24 or 48 hours. It involves electrodes (sticky patches) on your chest connected to a small recording device you carry (often on a belt or in a pocket). The Holter monitor records every heartbeat during that period. If you have daily palpitations, a 24-48 hour Holter may very well catch an episode. Holter monitors can sometimes be used for up to 7 days, but beyond that they become impractical with traditional technology.
- Event monitor: This is a device used for longer-term monitoring (often 1-4 weeks). Some event monitors are worn like a Holter but only record when you trigger them (or when they detect a very abnormal rhythm); others are small patches or devices you can activate when symptoms occur. Event monitors are useful if your palpitations are less frequent – say, they only happen once a week or a few times a month. You usually press a button to record a snippet when you feel symptoms.
- Consumer devices (smartphone ECGs or watches): In recent years, personal gadgets have entered the scene. Devices like the KardiaMobile or the Apple Watch’s ECG feature allow people to record a 30-second ECG on their own when they feel a palpitation. These can sometimes capture abnormalities, especially atrial fibrillation, and can be shown to your doctor. If you’re wondering how to monitor heart rhythm at home, these consumer tools are an option – but they rely on you to catch the moment of symptoms, and their recordings might be limited or not continuously stored. They also may not detect issues that happen when you’re not actively checking. So, while tech like smartwatches can alert you to potential irregular heart rates, they are not as comprehensive as medical-grade monitors.
When initial tests don’t find an arrhythmia but palpitations persist, doctors often opt for longer and more detailed monitoring. Traditionally, that meant extending Holter monitoring or using an event recorder. But wearable technology has advanced, and now there are newer solutions that can record your heart continuously for much longer periods – dramatically improving the chances of catching an elusive arrhythmia.
Limitations of Traditional Holter Monitors
Holter monitors have been a staple of cardiac investigation for decades. While they’re very useful, they do have some limitations that patients quickly discover:
- Short monitoring window: Standard Holters are worn for only 24 to 48 hours in most cases. If your irregular heartbeat doesn’t happen during that timeframe, the Holter won’t catch it. Some doctors can arrange longer Holter studies (a week or so), but the longer you wear the old-style equipment, the more cumbersome it gets. If your palpitations are infrequent (say one episode every 10 days), there’s a good chance a 1-2 day test will miss it.
- Wires and discomfort: A traditional Holter comes with several leads (wires) stuck onto your chest. You’ll typically have 5 to 7 sticky electrode pads connected by wires to a small recorder box. Under clothing, the electrodes and wires can tug or cause itchiness (some people even get skin irritation or rashes from the patches). You have to carry the recorder on your belt or in a pocket at all times. This setup is tolerable for a day or two, but it’s hardly pleasant. In fact, patients often find Holters inconvenient – one study noted that 76% of patients reported the Holter monitor disrupted their daily activities.
- No showering or swimming: While wearing a Holter you usually cannot get it wet. That means no showers – you have to sponge-bathe around it for the entire duration of the test. This is due to the electrodes and electronic device not being waterproof. It’s another reason people are eager to take the Holter off as soon as the test period ends.
- Data quality issues: The multiple leads and movement can sometimes create artefact (noise in the recording). If an electrode pops off or a wire shifts, parts of the recording might be unclear. Moreover, a Holter generates a huge amount of ECG data to analyse in 24-48 hours, which traditionally a technician had to sift through. If nothing obvious jumps out, subtle events could be overlooked (though newer Holter analysis software is improving this).
Because of these limitations, the standard Holter is often only the first step. If it comes back normal and palpitations persist, doctors might repeat the Holter or try an event monitor. But as you can imagine, doing multiple short-term tests can be inefficient and frustrating for both patient and doctor. This is why the development of longer-term, comfortable heart monitors is such a big deal. In the next section, we’ll talk about one of the best heart monitors for palpitations available today – a device that aims to overcome many of the Holter’s shortcomings.
Best Heart Monitor for Palpitations? How New Devices Like the Zio Patch Help
An example of a modern patch-style heart monitor (the Zio patch) worn on the chest. These lightweight patches have no wires, allowing comfortable long-term heart rhythm monitoring as you go about your daily life.
In recent years, wearable patch monitors have revolutionised how we investigate palpitations. The frontrunner is the Zio® patch, a small adhesive device placed on your chest that records your heart’s electrical activity continuously for up to 14 days. Unlike a Holter, it has no external wires – all the electronics are integrated in the patch, which sticks to the skin. This makes it far more comfortable and discreet: you can hide it under your clothes and even shower with it on (the patch is water-resistant).
Because you can wear the Zio patch for one to two weeks straight, it dramatically increases the chances of capturing an arrhythmia that occurs infrequently. Think about it: 14 days of monitoring covers a lot more of your life than a 24-hour snapshot. In a clinical study, the Zio patch detected significantly more arrhythmia events than a 24-hour Holter monitor – 96 events vs 61 in the comparison group – primarily thanks to the longer monitoring time. In that same study (conducted by Scripps Health), doctors were able to reach a definitive diagnosis in 90% of patients when using the patch’s 2-week data, compared to only 64% of the time with Holter data. In short, long-term monitors like Zio greatly improve the odds of finding out what’s going on.
Patient comfort and convenience are also major wins for the patch. Most people forget they’re even wearing a heart monitor after a few days. There are no beeping devices or daily interruptions – you simply live your life while the patch quietly records in the background. A survey of patients who tried both devices found that 81% preferred wearing the Zio patch over a traditional Holter monitor. That’s a huge vote of confidence from those who have experienced both. And it makes sense: there are no bulky gadgets to lug around, and you’re not tethered by wires. You can sleep comfortably and maintain your usual routine with minimal interference.
Another advantage is data quality and analysis. The Zio patch’s design (no loose wires) helps reduce noise in the signal. After you mail back the patch, advanced algorithms (with human expert oversight) analyse every heartbeat recorded. The result is a comprehensive report of your heart rhythm over the wear period. This report can reveal patterns – for example, if you have short bursts of atrial fibrillation at random times, or if your palpitations correlate with premature beats that are benign. By getting this “bigger picture” of your heart’s behavior, your doctor can make more informed decisions. Studies have even shown that using long-term continuous monitors like Zio leads to faster diagnoses and fewer repeat tests compared to traditional monitors. Essentially, you’re more likely to get answers on the first round, without having to keep coming back for additional monitoring.
Is the Zio patch available in the UK? Yes – the Zio XT patch is now used in the UK in both NHS and private settings. In fact, the UK’s National Institute for Health and Care Excellence (NICE) has evaluated and noted the Zio service as an innovative option for detecting cardiac arrhythmias, especially when initial tests are inconclusive. GPs and cardiologists in the UK can prescribe the Zio patch for patients with palpitations or suspected arrhythmias. The patch is sent to you and after your wear period you mail it back for analysis, making it very convenient. If you search for “Zio patch UK”, you’ll find that many leading heart clinics and hospitals now offer this technology as part of their diagnostic toolkit.
Of course, the Zio patch is just one example of new long-term monitors. There are other similar adhesive patches being developed, and in some cases for very elusive rhythm issues, doctors might even suggest an implantable loop recorder (a tiny device under the skin that can record for months or years). But for most patients with palpitations, a wearable patch like Zio hits the sweet spot: it’s non-invasive, relatively low-profile, and gathers a wealth of data.
Long-Term Monitoring: Reassurance or Actionable Answers
One of the greatest benefits of extended heart monitoring is the peace of mind it can provide. Palpitations can be scary – the uncertainty of not knowing what’s happening in your chest is often the worst part. With a 10-second ECG or a 24-hour monitor, you might still be left wondering if something was missed. But after 10-14 days of continuous monitoring, you can be much more confident in the results.
- If the long-term monitor finds no serious arrhythmia, that is very reassuring. You and your doctor may determine that your palpitations are due to extra beats or stress, but nothing dangerous. This knowledge alone can greatly reduce anxiety. Many patients feel less scared of their palpitations once heart disease and significant arrhythmias have been ruled out.
- If the monitor does detect an arrhythmia, you now have an actionable answer. Depending on the finding, there are often excellent treatments available. For example, if it turns out you have atrial fibrillation appearing intermittently, your doctor can start appropriate medications (to control the rate or prevent clots) and discuss longer-term options. If you have runs of SVT, you might be offered medications or a curative procedure (ablation). Even in rarer cases like identifying dangerous rhythms, having that information allows prompt intervention (such as an ablation or a device like a pacemaker/ICD) that could be life-saving. In all these scenarios, knowledge is power – catching the issue on a monitor is the first step to effectively managing it.
In sum, long-term monitoring either gives you reassurance or a clear direction for treatment. It takes the guesswork out of “was that something serious or not?” and replaces it with concrete data. In both outcomes, patients win: you get peace of mind or you get a diagnosis and plan. This is why at Keyhole Hockney we believe that investing in good diagnostic tools, like extended ECG monitors, is so worthwhile for patients experiencing palpitations.
When to Seek Professional Assessment
Palpitations are not always a sign of serious disease, but you should seek medical advice in certain situations. According to NHS guidelines, you should see your GP if your heart palpitations keep recurring, are getting worse, or lasting longer than a few minutes at a time. It’s especially important to get checked if you have known heart disease or if there’s a family history of sudden heart problems.
Pay attention to any other symptoms that accompany the palpitations. If you experience chest pain, significant shortness of breath, or feel faint/passing out during the palpitations, treat it seriously. These could indicate that the palpitations are due to a more dangerous arrhythmia or that your heart is under strain. Call 999 or seek emergency medical care immediately if palpitations come with chest pain, fainting, or severe breathlessness. Those could be signs of a heart attack or a very unstable rhythm that needs urgent attention. (Fortunately, this is rare, but it’s important to be safe.)
For more routine cases – say you have bothersome palpitations but without alarming symptoms – making an appointment with your GP or a cardiologist is wise. They can perform initial tests (like ECG, blood work for thyroid/anaemia, etc.) and decide if further monitoring is needed. Don’t hesitate to seek an evaluation just because you think “it might be nothing.” Doctors would rather check and find nothing serious than miss a problem. Even if it is nothing serious, you’ll gain peace of mind and maybe some tips to reduce the palpitations (for example, cutting down caffeine or managing stress).
Remember, you know your body best. If something feels off or your palpitations worry you, get them evaluated. Palpitations are a very common complaint, and healthcare providers are used to investigating them – you won’t be thought of as silly for “overreacting.” On the contrary, taking a proactive approach to your heart health shows good sense.
Conclusion: Taking Control of Your Heart Rhythm
In conclusion, heart palpitations are usually more frightening than they are harmful – but it’s completely understandable to seek answers and reassurance if you’re experiencing them. We’ve covered what causes palpitations, both the innocent triggers and the more serious causes, and explained why diagnosing an irregular heartbeat can sometimes be tricky with just a quick ECG. The encouraging news is that technology like the Zio patch now allows us to monitor heart rhythms at home over days or weeks, bridging the gap between your symptoms and a clear diagnosis. These longer-term monitors offer a powerful combination of comfort and diagnostic power – often providing either the reassurance that nothing serious is happening, or catching the arrhythmia in action so it can be treated.
If you’re struggling with palpitations or worrying about your heart rhythm, don’t wait in fear. Listen to your body and seek a professional assessment if needed. With modern cardiac monitoring tools and an experienced specialist to interpret the results, you can get to the bottom of what’s causing your palpitations. Knowledge and timely diagnosis bring peace of mind – and if treatment is needed, it can be started early to keep you safe and healthy.
The Keyhole Heart Clinic is here to help. Our team offers expert, patient-centred evaluations for palpitations and arrhythmias, including access to advanced monitoring like the Zio patch. We combine decades of cardiology experience with cutting-edge technology, all delivered with a warm, understanding approach. If you’re in the UK and looking for answers about your irregular heartbeat, consider reaching out for a consultation.
Feel free to book an appointment here to discuss your concerns and get personalised advice on the next steps. Remember, you don’t have to stay anxious or in the dark about your heart – help is available, and often the answer is just a monitor and a heartbeat away.
