You're sitting quietly, and suddenly your heart starts pounding hard in your chest, or you feel it "skip" a beat, or it starts racing for no reason. It lasts a few seconds, sometimes a few minutes, and then it stops. You're left with one question: is it serious?
Here's how a cardiologist approaches palpitations, and what tells apart a harmless episode from one that deserves attention.
What "palpitations" actually means
The word "palpitations" covers very different sensations: the heart beating too fast (tachycardia), too hard, irregularly, or the feeling of a missed beat followed by a stronger one (an extra beat, or "extrasystole"). This last one is by far the most common and, in the vast majority of cases, entirely benign: it's a slightly premature heart contraction, followed by a pause, that the heart "catches up" with a more forceful beat — hence that feeling of a "skip" followed by a "thump."
What a cardiologist does with palpitations
The interview is central, because palpitations can't be seen on examination: they've often stopped by the time of the visit. The cardiologist tries to get a precise description of the sensation — fast and regular, fast and irregular, a simple isolated "skip" —, its duration, how it starts and stops (sudden or gradual), the circumstances (exertion, rest, stress, position, after a meal or coffee), and associated symptoms: chest pain, breathlessness, dizziness, faintness.
The physical exam and ECG look for underlying abnormalities, even without palpitations at the time of the visit. But since a standard ECG only captures a few seconds, it only shows an abnormality if it's present at that exact moment.
To capture the episode itself, the cardiologist may prescribe a Holter monitor (continuous recording over 24 to 48 hours, sometimes longer), or an event recorder you trigger yourself when symptoms occur if they're more spaced out. It's often this recording, done during everyday life, that provides the answer.
A blood test is frequently ordered to rule out non-cardiac causes: a thyroid imbalance, anemia, or a potassium or magnesium imbalance can all cause palpitations.
The most common causes
- isolated extra beats — by far the most common cause, benign in the vast majority of cases;
- stress and anxiety, which speed up the heart rate via the nervous system;
- caffeine, alcohol, nicotine, well-identified stimulants;
- lack of sleep and fatigue, which lower the threshold for noticing beats;
- hormonal changes: pregnancy, menopause, periods;
- a thyroid disorder, particularly an overactive thyroid;
- more rarely, a structural heart rhythm disorder, such as atrial fibrillation, which requires specific diagnosis and follow-up.
The signs that should raise a flag
The vast majority of palpitations are benign, but certain elements change the picture and deserve a prompt, even urgent, opinion.
See a doctor promptly if the palpitations: last more than a few minutes continuously; are becoming more frequent or intense; occur systematically with exertion; are accompanied by unusual breathlessness or marked fatigue; affect someone with known heart disease, a structural heart condition, or a family history of sudden death.
Call 101 immediately if the palpitations come with: chest pain or pressure; severe breathlessness; intense dizziness or a feeling of impending faintness; loss of consciousness, even brief; cold sweats.
Loss of consciousness combined with palpitations is never trivial and requires urgent evaluation, even if everything has returned to normal by the time you reach the ER.
What to note down before your visit
Since palpitations have often stopped by the time of the appointment, the quality of your description matters a great deal. A few notes jotted down in the moment, even brief ones, help the cardiologist considerably.
Note the date and time of the episode, its approximate duration, what you were doing just before (resting, exerting yourself, stressed, after a meal, after coffee or alcohol), and how it stopped (gradually, suddenly, after coughing or changing position).
Describe the sensation in your own words: regular or irregular, a single isolated "skip" or a prolonged racing feeling, a strong thump or a fluttering sensation. There's no technical vocabulary to master — your spontaneous description is often more useful than a poorly used medical term.
Note any associated symptoms, even subtle ones: slight dizziness, chest discomfort, a feeling of warmth, sudden anxiety. These details, which sometimes seem secondary to you, often guide the diagnosis.
If episodes are frequent, a simple notebook or a note on your phone, kept for one to two weeks before the appointment, gives the cardiologist a far more useful overall picture than an isolated memory, inevitably approximate over time.
What the research says
According to the World Health Organization, heart rhythm disorders are among the most common reasons for a cardiology visit, and atrial fibrillation — the most common significant arrhythmia — becomes more prevalent with age. Appropriate management, once a rhythm disorder is confirmed, notably reduces the risk of complications, particularly the stroke risk associated with certain arrhythmias.
That said, let's keep things in proportion: the vast majority of palpitations reported during consultations don't correspond to any significant rhythm disorder. The goal of the diagnostic process isn't to medicalize every beat you notice, but to identify the minority of situations that truly warrant follow-up.
In practice, in Israel
Isolated, brief palpitations with no other symptom can be discussed at a scheduled consultation, through your health fund's covered pathway or in the private sector. A Holter monitor, when prescribed, is generally arranged quickly. Facing palpitations combined with chest pain, faintness, or loss of consciousness, don't look for the usual pathway: go to the ER or call 101.
Recurring palpitations, even if they only last a few seconds: a cardiologist's opinion lets you understand their origin and, in most cases, be reassured for good. Find a cardiologist near you on OlamKal and book an appointment.
To wrap up
Feeling your heart beat differently is unsettling, but rarely a sign of something serious. What matters is knowing how to tell apart the isolated, brief episode with no other symptom from the one accompanied by pain, breathlessness, or faintness — and never leaving an unexplained loss of consciousness unaddressed.
