Heart palpitations are a feeling: you notice your heart racing, fluttering, pounding, or seeming to skip a beat. An arrhythmia is an actual change in the heart’s speed or rhythm. Palpitations can happen when the rhythm is normal, and some arrhythmias cause no noticeable feeling at all. So, palpitations describe what you feel, while an arrhythmia describes how the heart is beating.
How are arrhythmia and heart palpitations different?
The main difference is that palpitations describe a sensation, while an arrhythmia is a change in the way the heart beats. These terms are related, but they do not mean the same thing. Someone may notice unusual heartbeats without having an abnormal heart rhythm, while another person may have an arrhythmia without feeling anything unusual.
According to the U.S. National Library of Medicine's MedlinePlus information on arrhythmia, an arrhythmia occurs when the heart beats too quickly, too slowly, or with an irregular pattern. The condition involves the rate or rhythm of the heartbeat, whereas palpitations describe the awareness of the heartbeat.
| Feature | Heart palpitations | Arrhythmia |
|---|---|---|
| What it means | A noticeable or unusual feeling of the heartbeat. | A change in the heart's rate or rhythm. |
| Is it a symptom or a condition? | A symptom or sensation, not a specific diagnosis. | A heart rhythm abnormality that may be identified through medical assessment. |
| Can it occur without other symptoms? | Yes. Palpitations may be the only noticeable experience. | Yes. Some arrhythmias produce no noticeable symptoms. |
| Does an unusual heartbeat always mean an arrhythmia? | No. The sensation can occur even when the heart rhythm is normal. | An arrhythmia involves an abnormality in the heart's rate or rhythm, although its effects vary. |
What do heart palpitations feel like?
Heart palpitations can make a person unusually aware of their heartbeat. The sensation may occur in the chest, neck, or throat. Some people notice it while exercising, resting, lying down, or going about their usual activities. The feeling can last for a few seconds, several minutes, or longer.
The NHS guidance on heart palpitations describes several ways people may experience them, including:
- A racing or unusually fast heartbeat.
- A pounding or thumping sensation in the chest.
- A fluttering feeling in the chest, neck, or throat.
- The sensation of skipped or extra heartbeats.
- An awareness that the heartbeat feels unusual or irregular.
These experiences can occur for different reasons. The feeling alone does not establish whether the heart's electrical rhythm is abnormal. The timing of the sensation, associated symptoms, medical history, and findings from an examination may help a healthcare professional determine what is happening.
What causes palpitations, and what causes an arrhythmia?
Palpitations can occur in response to everyday activities or changes in the body. They may also accompany a heart rhythm disorder. The MedlinePlus medical encyclopedia entry on heart palpitations explains that the heartbeat may be normal or abnormal when a person experiences this sensation.
Factors that may contribute to palpitations include:
- Physical exertion or strenuous exercise.
- Emotional stress or anxiety.
- Lack of sleep.
- Caffeine, nicotine, or alcohol.
- Some medicines, including certain cold and cough remedies.
- Hormonal changes associated with menstruation, pregnancy, or menopause.
- Medical conditions such as an overactive thyroid or iron deficiency anemia.
These factors do not necessarily cause an arrhythmia in every person. Some may make the heartbeat more noticeable, while others may be associated with changes in heart rate or rhythm. An arrhythmia may also be related to an underlying heart condition or changes in the electrical signals that coordinate the heartbeat.
Can palpitations occur when the heart rhythm is normal?
Yes. Palpitations do not always mean that the heart has an abnormal rhythm. A person may notice a forceful heartbeat after exercise or during stress even when the rhythm is otherwise normal. Some palpitations may also be related to occasional extra heartbeats, which can feel like a pause followed by a stronger beat.
In other situations, palpitations may be a sign of an arrhythmia. Examples of rhythm disorders include atrial fibrillation, which involves an irregular heartbeat, and tachycardia, which refers to a heart rate that is faster than expected for the circumstances. A sensation of racing or fluttering cannot reliably distinguish these conditions from other explanations.
Can an arrhythmia occur without palpitations?
Yes. Some arrhythmias cause noticeable racing, fluttering, or skipped beats, but others may not produce symptoms that a person can feel. An abnormal rhythm may sometimes be identified during a routine examination or heart test performed for another reason.
The American Heart Association's explanation of arrhythmia describes how the heart relies on organized electrical signals to coordinate its contractions. A disturbance in those signals can change the heartbeat, even when the person is not aware of a problem.
How do healthcare professionals tell the difference?
Because the symptoms of palpitations and arrhythmias can overlap, clinicians consider more than the way a heartbeat feels. They may ask when the episodes began, how often they occur, how long they last, whether they start and stop suddenly, and whether they happen during activity or at rest. They may also review medicines, other health conditions, family history, and accompanying symptoms.
An electrocardiogram, also called an ECG or EKG, records the electrical activity of the heart. It can help identify an abnormal rate or rhythm when the relevant finding is present during the test. However, an ECG performed between episodes may not capture an intermittent rhythm disturbance.
According to Mayo Clinic's guidance on diagnosing heart palpitations, clinicians may recommend additional heart monitoring when an ordinary ECG does not explain the symptoms. Depending on the circumstances, this may include:
- Holter monitoring: A portable ECG device that records the heart's electrical activity over a period of time during everyday activities.
- Event recording: A monitoring device used to help capture rhythm changes that occur intermittently.
- Other tests: Blood tests or an echocardiogram may be considered when the history and examination suggest a need to assess possible contributing conditions or the heart's structure.
Not everyone with palpitations needs every test. The choice depends on the person's symptoms, medical history, examination findings, and whether an abnormal rhythm is suspected.
When should you seek medical attention?
Brief palpitations without other concerning symptoms are often not caused by a serious heart problem. However, recurring episodes, symptoms that are becoming more frequent, or palpitations that last longer than usual should be discussed with a healthcare professional. Evaluation is particularly important for people with a known heart condition or a family history of heart problems.
Seek emergency medical care if palpitations are occurring with chest pain or discomfort, shortness of breath, fainting, or a feeling that you may pass out. If these symptoms have stopped, urgent medical assessment may still be appropriate. The NHS guidance on heart palpitations provides further advice on recognizing symptoms that need immediate attention.
When arranging an appointment for recurring palpitations, it may help to note when an episode happens, how long it lasts, what you were doing, and whether other symptoms occur at the same time. A record of medicines and supplements can also help the clinician assess possible contributing factors.
What is the key takeaway?
Heart palpitations are the feeling of an unusual heartbeat, while an arrhythmia is an actual change in the heart's rate or rhythm. Palpitations may occur with a normal rhythm or because of an arrhythmia, and some arrhythmias produce no noticeable symptoms. When symptoms are persistent, changing, or accompanied by warning signs, a medical assessment can help determine whether heart rhythm testing or other evaluation is needed.