Palpitations & Arrhythmias

A sudden racing heartbeat, a flutter in the chest, or a pause followed by a strong thump can feel unsettling. You may notice it while resting, trying to sleep, exercising or going about your day. Sometimes the episode has stopped by the time you reach a doctor.

Palpitations are the sensation of noticing your heartbeat. An arrhythmia is an abnormal heart rhythm. Palpitations can occur with a normal rhythm, and some arrhythmias cause few or no symptoms.

Many episodes have a reassuring explanation, including occasional extra beats. Others need treatment. The useful next step is to understand what rhythm is occurring, whether there is an underlying heart condition, and what the symptoms mean for you.

Dr. Kulin Sheth, an interventional cardiologist in Ahmedabad, assesses unexplained palpitations and reviews established rhythm diagnoses at Sheth Heart Clinic, Bopal. Whether you are looking for an explanation or have already been advised medicines, ablation or a device, he can help you understand the findings and the next decision.

The heart normally speeds up with exercise, fever, stress or excitement. Sleep loss, dehydration, nicotine, alcohol, energy drinks and some medicines can also contribute. Anaemia, thyroid disorders and electrolyte disturbances are other possible causes.

Tea or coffee may trigger symptoms in some people, but everyone does not need to stop them completely. Your own pattern matters. Bring a list of prescribed medicines, inhalers, cold remedies and supplements to the consultation; do not stop prescribed treatment on your own.

What does a skipped beat mean?

An early heartbeat may be followed by a brief pause and a stronger beat. You may feel the pause or thump more than the early beat itself. These are often called extra beats, ectopics, premature atrial contractions (PACs) or premature ventricular contractions (PVCs), depending on where they start.

Occasional extra beats are often reassuring when the rest of the assessment is normal. Frequent extra beats, troublesome symptoms or an underlying heart condition may need closer review. Very frequent PVCs can sometimes weaken the heart's pumping function.

The strength of the sensation alone cannot tell you how serious the rhythm is.

If a report says “irregular heartbeat”, ask which rhythm was actually recorded. This description alone does not establish a diagnosis or tell you which treatment is needed.

Heart block is an electrical conduction problem. It is different from a blockage in a coronary artery. These diagnoses cannot be distinguished reliably by symptoms alone.

When do palpitations need urgent help?

Seek emergency care now if palpitations occur with chest pain or pressure, severe breathlessness, fainting, collapse or marked ongoing dizziness with weakness. Do not drive yourself if you feel faint or unwell. Do not wait for a clinic appointment or a WhatsApp reply.

Sudden facial drooping, arm weakness, difficulty speaking or sudden loss of vision may indicate a stroke. Seek emergency care even if these symptoms improve.

If someone collapses, is unresponsive and is not breathing normally, call emergency services immediately, start CPR and use an available AED according to its instructions.

Episodes during exertion, near-fainting, recurrent unexplained symptoms, known heart disease or a family history of sudden unexplained death deserve timely assessment even when the episode has stopped. A new, sustained rapid or irregular heartbeat also needs prompt medical assessment, particularly if you feel unwell.

Our information on chest pain and heart attack warning signs explains related symptoms that should not be ignored.

A resting ECG records the heart's electrical activity for a short period. It can identify important findings, but a normal ECG between episodes does not rule out an intermittent arrhythmia.

The history helps decide what to do next: whether episodes start and stop suddenly, how long they last, whether the pulse feels regular, what you were doing, and whether there was dizziness, chest discomfort or breathlessness. Existing ECGs recorded during an episode are especially useful.

Choosing a rhythm monitor

If symptoms happen daily, a 24–48-hour Holter monitor may capture them. Less frequent episodes may need a longer continuous recording, patch monitor, external loop recorder or event recorder. Rare but concerning events, particularly unexplained fainting, may warrant specialist assessment and an implantable loop recorder.

The aim is to connect what you feel with the rhythm at that moment. Record the time and symptoms, and use the monitor's event button if provided. A normal rhythm during your usual symptoms is a different finding from a recording during which your usual episode never occurred.

Smartwatch ECG recordings can sometimes help. Save the actual trace if available, rather than only a heart-rate number or notification. Automated alerts need clinical review and may require confirmatory ECG recording; a watch cannot reliably exclude every rhythm problem. Do not delay urgent care to make a recording.

Depending on the findings, assessment may include blood count, thyroid function, electrolytes or an echocardiogram. An echo checks heart structure and pumping function; it does not replace rhythm monitoring. ECG, echocardiography and other cardiac tests answer different questions, and everyone does not need every test.

Many common SVTs are treatable and are not usually life-threatening in an otherwise structurally normal heart. They can still be distressing and disruptive. The specific rhythm, associated heart disease and symptoms matter, particularly if an episode causes fainting, chest pain or severe breathlessness.

Dr. Kulin reviews the ECG or monitoring record, previous treatment and how episodes affect your life. Infrequent, well-tolerated episodes may be managed differently from recurrent episodes that interrupt work, sleep or daily activities.

Options may include observation, medicines or catheter ablation, which targets the electrical pathway or tissue responsible for selected rhythms. For some common recurrent SVTs, ablation can offer a definitive treatment option. Benefits, procedure risks and the possibility of recurrence should be discussed for the particular rhythm; it is not a guaranteed cure for every SVT.

If appropriate, you may also be taught a safe manoeuvre to try during a familiar episode, with clear instructions about when to seek help. Do not attempt neck massage or take extra medicine without an agreed plan. Specialist electrophysiology assessment can be coordinated when needed.

In atrial fibrillation, or AF, the upper chambers activate irregularly. You may feel palpitations, tiredness, reduced exercise tolerance or breathlessness, or have no noticeable symptoms.

Treatment addresses two separate questions: how to manage the heart rate or rhythm, and how to reduce the risk of stroke. AF can allow blood clots to form in the heart and travel to the brain. Feeling well does not remove that risk.

Whether you need an anticoagulant, often called a blood thinner, depends on your individual stroke risk and clinical circumstances. Age, previous stroke, high blood pressure, diabetes, heart failure and vascular disease contribute to that assessment. Bleeding history, kidney function, other medicines and valve disease help guide safe treatment selection and follow-up.

Aspirin is not a substitute for an anticoagulant when anticoagulation is indicated for AF. Mechanical heart valves and moderate-to-severe mitral stenosis require particular consideration when choosing treatment.

Do not stop an anticoagulant because palpitations have settled, an ECG is normal, or rhythm treatment has worked. Longer-term treatment depends on reassessment of stroke risk and your clinical situation. Medicines used to slow the pulse and medicines used to prevent clots have different purposes.

Managing high blood pressure, diabetes, excess weight, alcohol intake and sleep apnoea where present is also part of AF care.

Treatment follows the documented rhythm and your circumstances. Some patients need explanation and observation; others need active treatment to improve symptoms or reduce risk.

• Addressing contributors: Treat anaemia, thyroid or electrolyte problems where present, review relevant medicines and work on individual triggers.
• Medicines: Selected medicines can slow a fast pulse or help maintain a normal rhythm. The choice depends on the rhythm, heart function, other conditions and possible side effects.
• Cardioversion: A controlled electrical treatment under sedation, or selected medicines, can restore normal rhythm in appropriate situations. AF cardioversion requires careful attention to clot risk and anticoagulation.
• Catheter ablation: Thin catheters passed through blood vessels identify and treat the source of selected abnormal rhythms. Suitability, benefits and risks differ between SVT, AF, flutter and ventricular arrhythmias.
• Implanted devices: Pacemakers, ICDs and CRT devices have specific roles. They are not routine treatments for every palpitation or irregular heartbeat.

A pacemaker primarily supports selected slow rhythms or electrical conduction problems. An implantable cardioverter-defibrillator, or ICD, detects and treats certain dangerous rhythms from the lower chambers. Depending on the system and rhythm, treatment may involve rapid pacing or an electrical shock.

Some ICDs also provide pacemaker functions, which can make the terminology confusing. An ICD may be advised after a serious ventricular rhythm event or to prevent sudden cardiac death in selected people at high risk, even before such an event occurs. It does not cure the underlying heart condition or prevent every abnormal rhythm.

If you have been advised a device, the discussion should establish its exact name, the risk it addresses, the expected benefit and the alternatives. Dr. Kulin can review the rhythm records, heart-function assessment and proposed treatment with you. An urgent recommendation should be addressed promptly rather than postponed for a routine second opinion.

The pacemaker page explains pacing treatment. Options can include conventional single- or dual-chamber systems, leadless pacemakers and conduction system pacing, selected according to individual needs. These describe different aspects of pacing and are not all mutually exclusive choices. The ICD and CRT page explains devices used for dangerous ventricular rhythms and selected heart-failure conditions.

Many people with palpitations or treated arrhythmias continue their usual work and activities. Advice depends on the rhythm, whether it causes fainting or other significant symptoms, and whether there is underlying heart disease.

Until unexplained exertional symptoms or fainting have been assessed, avoid activities where another episode could put you or others at risk. Driving and safety-sensitive work may need specific advice. Once the diagnosis is clear, ask what activity is suitable and how to return to exercise safely.

Follow-up may check symptoms, medicine effects, rhythm recordings and heart function where relevant. If you have an implanted device, regular device checks remain important even when you feel well.

You may want help understanding an SVT or AF diagnosis, an inconclusive Holter report, long-term medicines, or a recommendation for ablation, anticoagulation, a pacemaker or an ICD.

Dr. Kulin personally reviews existing reports and available recordings or images before deciding whether further assessment is appropriate. Bring your ECGs, full monitoring reports, echo reports, discharge summaries and current medicine list. Reviewing what has already been recorded may be more useful than repeating tests without a clear question.

A cardiology consultation can help clarify what is known, what remains uncertain and which options fit your situation. Seek emergency care first if you have urgent warning signs.

References

• 2024 European Society of Cardiology guideline on atrial fibrillation
• 2023 ACC/AHA/ACCP/HRS guideline on atrial fibrillation
• ISHNE–HRS expert consensus on ambulatory ECG and external rhythm monitoring
• NICE recommendations on atrial fibrillation diagnosis and management
• European Society of Cardiology guideline on supraventricular tachycardia
• European Society of Cardiology guideline on ventricular arrhythmias and sudden cardiac death prevention
• 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing, including conduction system pacing