We're all familiar with the metaphor 'my heart skipped a beat' - used to describe a moment of shock or excitement. But what happens when our heart really does seem to miss a beat, flutter or change rate for a moment? Heart palpitations are more common than you might think. We look at the symptoms, causes and when to seek help.
Am I having a heart attack?
"Someone having a heart attack is more likely to feel a pain or tightening across the chest rather than the feeling of a skipped heartbeat," explains Lucy Martin, senior cardiac nurse at the British Heart Foundation. "Other common symptoms are sweating, shortness of breath and feeling sick; or a pain that radiates along the arm or up to the jaw."
If you are experiencing any of the above symptoms, it's important to seek urgent medical care.
What causes palpitations?
If you are suffering from palpitations, it's important to consider what might be causing them. Working out initially what you're feeling is key. Most people use the term palpitations to describe a rapid, racing or thumping but still regular heartbeat. If this is the case, think about when the palpitations occur and whether there might be a lifestyle or dietary trigger.
"It's not uncommon for people to get palpitations during vigorous exercise," explains Martin. "Or when they're feeling anxious or stressed.
"Other triggers might include alcohol, caffeine, tobacco, certain medications and recreational drugs."
In addition, palpitations in women might be caused by hormonal fluctuations experienced during periods, pregnancy or during menopause. Some medications, including the asthma inhaler salbutamol, can also lead to palpitations, especially if you take a large amount.
Whilst palpitations may have environmental, behavioural or dietary factors, there are also medical conditions that may cause palpitations with a regular rhythm. These include having an overactive thyroid, low blood sugar (hypoglycaemia), suffering from anaemia or being dehydrated.
Your doctor may decide to perform blood tests for blood sugar control if you have diabetes, to check your thyroid hormone levels and see whether you are low in iron.
Of course, palpitations may also signify a problem with your heart that may require further treatment. For example, you may have a condition known as atrial fibrillation which causes an irregular heartbeat.
"We recommend that if you're experiencing palpitations you check your pulse to see whether your heartbeat is regular," advises Martin. "If you find that it is irregular, we'd recommend you see your GP who can then check you over and carry out an ECG if necessary."
Supraventricular tachycardia, or SVT, can affect healthy adults of any age if they have a short-circuit in the electrical pathways in the heart which control our heart rhythm. It leads to episodes of regular, rapid heartbeat (usually between 140 and 200 beats per minute) and can be accompanied by shortness of breath, dizziness and sometimes chest discomfort.
Serious conditions such as hypertrophic cardiomyopathy, problems with the heart valves or heart failure may cause palpitations, so if you are at all concerned it's worth talking things over with your GP.
Tests and diagnosis
Visiting the GP to talk about palpitations may seem nerve-wracking, but is likely to result in reassurance. Your GP will start by taking a history, perform an examination and, if necessary, may order blood tests or perform an ECG.
"Probably the two most important risk factors are actually palpitations on exertion or those with blackouts," explains Dr Youssef Beaini, GP and specialist in cardiology at The Bonds Clinic.
"I recommend GPs categorise patients into green, amber or red depending on their history, symptoms and any risk factors they may have - for example, a history of heart problems, or blackouts."
"They may also order a 24-hour ECG to maximise the chance of picking up a problem, although these may not pick up problems that occur more infrequently."
New technology such as AliveCor heart monitors that attach to a mobile phone or the ECG app on Apple Watch Series 4 may also eventually become more widely available.
"These devices enable patients to perform a heart trace on their mobile phone so would enable GPs to investigate palpitations more thoroughly," explains Beaini.
When to seek advice
Whilst experiencing heart palpitations can be alarming, in the majority of cases such symptoms resolve without intervention, or with simple dietary or lifestyle changes.
"Of course if people have additional symptoms or a history of heart problems, they should seek urgent advice," says Martin. "We also recommend that people visit their GP if their palpitations last a long time, if they don't improve or if they feel as if they are worsening over time.
"Visiting the GP is also recommended for those who develop other symptoms or have a history of heart problems. Even if your symptoms are mild but they are causing you concern, it's sensible to talk these over with your doctor."