Heart
Palpitations
A sensation that your heart is racing, fluttering, pounding, or skipping a beat.
Palpitations — a racing, fluttering, or irregular heartbeat sensation — are a common presentation with causes ranging from benign lifestyle triggers to significant arrhythmias. Specialist evaluation identifies underlying causes and determines necessary treatment.
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Palpitations can range from harmless flutters to warning signs of underlying arrhythmias that require medical evaluation.
Palpitations: Feeling a Heartbeat You Normally Wouldn't
Palpitations are simply an awareness of your own heartbeat — a racing, pounding, fluttering, or a single hard thump followed by a pause. You are not usually meant to notice your heart at all, so feeling it can be unsettling even when nothing is wrong.
They are one of the commonest reasons people come to see a cardiologist, and the great majority turn out to be harmless. That said, palpitations deserve a proper explanation rather than a wave of the hand, because a small number are the surface sign of a rhythm that needs treatment.
They are one of the commonest reasons people come to see a cardiologist, and the great majority turn out to be harmless. That said, palpitations deserve a proper explanation rather than a wave of the hand, because a small number are the surface sign of a rhythm that needs treatment.
What Is Usually Behind Them
Most palpitations trace back to one of a familiar list of causes.
- Everyday triggers — caffeine, alcohol, nicotine, poor sleep, stress and anxiety, a heavy meal, dehydration, or the adrenaline of exercise
- Hormonal and metabolic — an overactive thyroid, perimenopause, pregnancy, anaemia, fever, or a low blood sugar
- Medicines — decongestant cold remedies, salbutamol inhalers, some supplements and slimming products
- A genuine arrhythmia — harmless extra beats (ectopics), SVT, or atrial fibrillation
The Clues in How They Feel
The pattern often points to the cause before any test. A sudden switch to a fast, regular pounding that stops as abruptly as it started suggests SVT. An irregular, sustained fast beat suggests atrial fibrillation. A single thump or skip with an otherwise normal pulse is almost always a harmless ectopic beat.
Two features raise the priority: palpitations that come on with exertion, and palpitations that make you feel you are about to faint. Keeping a short diary, or catching a trace on a smartwatch, is genuinely helpful.
Two features raise the priority: palpitations that come on with exertion, and palpitations that make you feel you are about to faint. Keeping a short diary, or catching a trace on a smartwatch, is genuinely helpful.
Getting to the Bottom of It in Singapore
The whole aim is to record the rhythm while you are having symptoms. We start with a resting ECG and, depending on how often episodes occur, a 24-hour to 14-day Holter or patch monitor (around SGD 300 to SGD 600), an event recorder, or a small implantable loop recorder for rare episodes.
An echocardiogram checks the heart's structure, and blood tests look for thyroid overactivity and anaemia. This can be arranged quickly at Paragon Medical Centre on Orchard Road.
An echocardiogram checks the heart's structure, and blood tests look for thyroid overactivity and anaemia. This can be arranged quickly at Paragon Medical Centre on Orchard Road.
Treatment, and When to Worry
If the work-up is reassuring, treatment is often just cutting back on triggers and, where anxiety is driving the sensation, addressing that directly. A treatable cause — an overactive thyroid, iron deficiency — is corrected. For SVT, we teach vagal manoeuvres and offer a curative ablation if episodes recur. Troublesome ectopic beats sometimes warrant a low-dose beta-blocker.
Call 995 if palpitations come with fainting, a collapse, chest pain, or breathlessness at rest. Otherwise, palpitations are a clinic problem, not an emergency.
Call 995 if palpitations come with fainting, a collapse, chest pain, or breathlessness at rest. Otherwise, palpitations are a clinic problem, not an emergency.
Palpitations: Common Questions
Concerned About Palpitations?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.