Circulation

Heart palpitations: what that fluttering is, and when to get it checked.

A skipped beat at 11pm can be alarming in a way it never is at 11am. Here’s what the NHS and the British Heart Foundation say causes palpitations, why they show up at night, and the specific signs that mean it’s time to speak to someone.

NK Medically reviewed by Dr Nouman Kazmi, MBBS FCPS ·8 min read

Key Takeaways

The NHS says heart palpitations are common and not usually a sign of anything serious. The BHF puts it the same way: unpleasant, but in most cases harmless.
The everyday causes are the ordinary ones. Strenuous exercise, lack of sleep, stress and anxiety, some medicines, and alcohol, caffeine or nicotine.
They feel worse at night mostly because there is less going on to distract you, not because something changes after dark.
A faster, slower or more noticeable heartbeat is on the NHS list of menopause symptoms, and hot flushes can bring palpitations with them.
Anaemia, an overactive thyroid and heart rhythm problems can all cause them. A GP can check the first two with a blood test and the third with an ECG, which takes a few minutes.
Call 999 or go to A&E if palpitations do not go away, or come with chest pain, shortness of breath, or feeling faint.

In This Article

What a palpitation actually is
The everyday causes
Why they show up at night
Menopause and hormonal change
When something else is behind it
Where blood pressure fits
What helps day to day
When to see a GP
Frequently asked questions
The bottom line

What a palpitation actually is

Most of the time your heart beats without ever asking for your attention. A palpitation is what it’s called when it does ask. The British Heart Foundation describes the sensation plainly: palpitations feel like your heart is racing, pounding, fluttering or like you have missed heartbeats.

That last one is the version people tend to find hardest to shake off. The sense of a beat going missing, then arriving late with a thump. It’s a strange thing to feel in your own chest, and it’s very easy to sit with it for a week without mentioning it to anyone.

So here’s the reassuring part up front, before the detail buries it. The NHS says heart palpitations are common and not usually a sign of anything serious. The BHF says much the same, adding that although they can be unpleasant, palpitations are common and in most cases harmless. In its Ask the Experts column the BHF goes one step further and names the gap that makes them so unsettling: palpitations are usually harmless and often feel more serious than they are.

None of that means you should ignore them. It just means the most likely explanation is an ordinary one, and there’s a clear line, set out further down this page, for when it isn’t.

A few minutes

That is how long an ECG takes, according to the BHF, and it is painless. If palpitations keep happening, that short test is usually the first thing a GP arranges. Handy to know before you decide whether the appointment’s worth the bother.

The everyday causes

The NHS lists five common causes of heart palpitations, and none of them involves your heart being damaged:

strenuous exercise
lack of sleep
stress and anxiety
medicines
alcohol, caffeine, nicotine and recreational drugs

Read that list against a normal week and most people find two or three of them in there. A late night, a second coffee to get through the afternoon, a stretch at work you’d rather was over. The BHF adds hormonal changes, ectopic beats, smoking and vaping, and foods that trigger them for some people.

Anxiety deserves its own line, because it works in both directions. The BHF is direct about it: anxiety can make your heart race, and palpitations themselves can trigger feelings of anxiety. Noticing your heartbeat makes you watch for it, watching for it makes you tense, and being tense makes it more likely you notice the next one. That loop is common, and it isn’t a character flaw.

On medicines, check rather than guess. If you started something new around the time the palpitations began, mention it to your GP or pharmacist, and leave any decision about the medicine itself to them.

Why they show up at night

Palpitations at night are the version people ask about most, and the BHF’s answer is more ordinary than you’d expect. We’re less distracted at night and there’s less noise, so we’re more aware of sensations in our bodies.

In other words, they’ll very likely have been happening during the day too. Lying in a quiet room with nothing to look at is simply the first moment you had a chance to notice.

Two other things stack on top of that. The BHF notes that anxiety and stress can make palpitations feel worse, so this may also be a reason for noticing them more at night, which is when a worry usually gets its clearest run at you. And position plays a part: people who sleep on their backs may be more likely to feel palpitations because of pressure changes in the body when in bed, while sleeping on the left side can make them more noticeable because of the shorter distance between the heart and the chest wall.

Keep a symptom diary

The BHF suggests keeping a symptom diary so your doctor can understand what you have been experiencing. Note the time, roughly how long it lasted, what you had eaten or drunk, and what you were doing. Three weeks of that is worth considerably more in an appointment than trying to describe it from memory.

Menopause and hormonal change

If palpitations have arrived alongside other changes in your forties or fifties, there’s a good chance they’re connected, and it isn’t a coincidence you should have to work out for yourself. The NHS lists a faster, slower or more noticeable heartbeat as a symptom of menopause and perimenopause. Palpitations is the word it uses for it.

Hot flushes carry it too. The NHS says a flush can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. So a flutter that arrives with a wave of heat at three in the morning isn’t a second problem to solve, it’s a recognised pattern.

Raise it with a GP anyway, instead of filing it under things you just put up with. Partly because the other causes on this page still need ruling out, and partly because blood pressure tends to shift in the same window. Our piece on perimenopause and blood pressure goes into that combination in more detail.

When something else is behind it

Alongside the everyday causes, the NHS also names menopause, pregnancy, iron deficiency anaemia, an overactive thyroid, heart rhythm problems and heart valve disease. Three of those deserve a closer look, because they are the ones a GP can get an answer on quickly.

Iron deficiency anaemia

Noticeable heartbeats, described by the NHS as heart palpitations, are a symptom of iron deficiency anaemia. The check is a blood test. The GP will usually do a full blood count to find out whether the number of red blood cells you have is normal.

An overactive thyroid

The NHS lists an irregular and unusually fast heart rate among the symptoms of an overactive thyroid. Again the route is straightforward: see a GP if you have symptoms, and if they think you might have a thyroid problem they can arrange a blood test to check how well your thyroid is working.

Atrial fibrillation

Atrial fibrillation, often shortened to AF, is described by the NHS as a type of heart rhythm problem where your heartbeat is not steady. The tell is that your pulse isn’t steady either, which is something you can feel at your wrist. The NHS says to see a GP if you think you may have symptoms of atrial fibrillation, or if you have heart palpitations that keep happening or are getting worse.

For any of these the first test is usually the same. The BHF explains that your GP may arrange for you to have an electrocardiogram, an ECG, to check whether the heart rate is regular and at a normal rate, and that this painless test lasts a few minutes. If the ECG shows anything unexpected, or the symptoms carry on, further testing or longer-term heart monitoring may follow.

Where blood pressure fits

This is the part to be precise about, because a home blood pressure monitor is the device most people already own, and it’s easy to expect more from it than it offers.

A cuff reading tells you the pressure in your arteries. It isn’t a rhythm test. If your monitor shows an irregular heartbeat symbol, treat that as a prompt to mention it to a GP, never as an answer in itself. The test that looks at rhythm is the ECG described above, and it takes a few minutes in a surgery.

What your cuff is genuinely good for is the other half of the picture. Blood pressure moves around during the day, which is normal, and a single reading taken on a morning when you’d already felt your heart thumping is close to useless on its own. A run of readings over six to eight weeks is a different thing entirely, and it’s the sort of evidence that turns a vague appointment into a specific one.

Two records, one appointment

If you’re already keeping a symptom diary for the palpitations, add your blood pressure readings to it. The Matter BP Tracker is free and keeps the trend for you, so a GP sees several weeks at a glance instead of one number taken on an unrepresentative Tuesday.

What helps day to day

Once a GP has looked and isn’t worried, the BHF’s own suggestions are modest and practical:

eat smaller meals
cut back on caffeine and alcohol
try breathing exercises
check with a doctor before starting to exercise
report any new palpitations to a healthcare professional or pharmacist

The BHF doesn’t present any of that as a fix, and it shouldn’t be read as one. It is a set of adjustments aimed at the most common triggers, which is often enough to shift things from noticing them most evenings to noticing them occasionally.

The breathing one tends to get dismissed as fluff, which is a shame, because it’s aimed squarely at the anxiety loop described earlier, not at the heart itself. If watching for the next palpitation is part of what brings it on, then something that interrupts the watching is doing real work.

When to see a GP

The NHS gives a clear non-urgent list. See a GP if you have had heart palpitations and feel well, but:

they keep coming back or they are happening more often
they last longer than a few minutes
you have a heart condition
you have a history of heart problems in your family

The BHF adds a useful middle option for the times you’re unsure but not alarmed. If your palpitations are frequent or prolonged, or you’re having symptoms such as chest pain or dizziness too, talk to your GP, or call 111 if you’re concerned.

Call 999 or go to A&E if you currently have heart palpitations and they do not go away, or you also have any of these symptoms: chest pain, shortness of breath, or feeling faint or fainting. That’s the NHS wording, and it’s the one part of this page not to weigh up.

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Frequently asked questions

When should I be worried about my heart palpitations?

The NHS says to see a GP if you feel well but the palpitations keep coming back, are happening more often, last longer than a few minutes, you have a heart condition, or you have a family history of heart problems. Call 999 or go to A&E if palpitations do not go away, or if they come with chest pain, shortness of breath, or feeling faint or fainting. The BHF adds that if they are frequent or prolonged, or come with chest pain or dizziness, you can talk to your GP or call 111 if you’re concerned.

What is the most common reason for heart palpitations?

There’s no single answer, but the NHS lists five common causes: strenuous exercise, lack of sleep, stress and anxiety, medicines, and alcohol, caffeine, nicotine or recreational drugs. The BHF adds ectopic beats, hormonal changes, smoking and vaping, and foods that trigger them for some people. The NHS describes palpitations as common and not usually a sign of anything serious.

How do I stop heart palpitations at night?

The BHF explains that palpitations often seem worse at night simply because we’re less distracted and there’s less noise, so we’re more aware of sensations in our bodies. Sleeping on your back, or on your left side, can also make them more noticeable. Its general suggestions are to eat smaller meals, cut back on caffeine and alcohol, and try breathing exercises. If they keep happening, keep a symptom diary and speak to your GP instead of working through it alone.

Can stress cause heart palpitations?

Yes. Stress and anxiety are on the NHS list of common causes. The BHF notes that anxiety can make your heart race, and that palpitations themselves can trigger feelings of anxiety, so the two can feed each other. It suggests grounding techniques, relaxation methods and talking therapies as ways to manage that side of it.

Can the menopause cause heart palpitations?

The NHS lists a faster, slower or more noticeable heartbeat, described as palpitations, among the symptoms of menopause and perimenopause. It also says hot flushes can cause palpitations or anxiety, or make you feel dizzy. That does not mean the other causes should be skipped over, so still raise it with a GP.

What vitamin am I lacking if I have heart palpitations?

The honest answer is that it’s not usually about a vitamin, and it’s not something to self-diagnose. The NHS does list iron deficiency anaemia as a cause of noticeable heartbeats, and a GP checks that with a full blood count blood test. An overactive thyroid is also on the list, and that is checked by a blood test too. Both are quick to rule in or out, which is a good reason to ask.

What foods should I avoid if I have heart palpitations?

The BHF names caffeine and alcohol specifically, and notes that some people have foods that trigger palpitations for them. It also suggests eating smaller meals. Since triggers vary from person to person, a symptom diary noting what you’d eaten or drunk beforehand is usually more useful than a general list.

What can be mistaken for heart flutters?

Ectopic beats, which the BHF lists as a cause of palpitations, are extra or early beats that can feel like a missed beat followed by a thump. Anxiety and panic attacks can produce a very similar sensation, and the NHS lists both stress and anxiety as common causes. An ECG is what tells these apart, and the BHF says the test is painless and lasts a few minutes.

The bottom line

A fluttering or thumping heartbeat is common, and the NHS and the BHF both say it is not usually a sign of anything serious. Sleep, stress, caffeine, alcohol and hormonal change account for a lot of them, and the reason they feel worse at 2am is mostly that there’s nothing else competing for your attention.

The line to hold in mind is the one the NHS draws. If they keep coming back, last more than a few minutes, or arrive with chest pain, breathlessness or feeling faint, that’s the moment to stop weighing it up and get it looked at. A few weeks of notes, and your blood pressure readings alongside them, will make that appointment a much shorter one.

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References

NHS. Heart palpitations. Available at: nhs.uk
British Heart Foundation. Palpitations. Available at: bhf.org.uk
British Heart Foundation. Heart palpitations at night (Ask the experts). Available at: bhf.org.uk
British Heart Foundation. When to worry about heart palpitations (Ask the experts). Available at: bhf.org.uk
NHS. Menopause and perimenopause: symptoms. Available at: nhs.uk
NHS. Atrial fibrillation. Available at: nhs.uk
NHS. Iron deficiency anaemia. Available at: nhs.uk
NHS. Overactive thyroid (hyperthyroidism). Available at: nhs.uk

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