We all have these unusual heartbeats—here’s how to tell what they really mean…

Chances are, you hardly ever notice the steady rhythm of your heart, even though it beats approximately 100,000 times a day. But there may be times when you can feel your heart beating. Perhaps it’s racing, even though you haven’t done anything strenuous. Or maybe you notice a fluttering sensation…an abrupt thump…or a flip-flop feeling.

Is this a sign that something is seriously wrong with your heart or just a harmless “glitch” in your normal heartbeat?


Most people think of heart palpitations as a racing or pounding sensation in the heart, but the term actually applies whenever you have any unpleasant awareness of your own heartbeat. Palpitations can be normal—when you exercise, for example, you’ll feel your heart pounding.

Heart palpitations also can be caused by arrhythmias, heartbeat irregularities that may (or may not) be harmless. For example, if you’re under a lot of stress, drink too much coffee or use a cold medicine with a stimulating ingredient (such as pseudoephedrine), you may experience arrhythmias.

When there may be a problem: If palpitations are repetitive or recurrent over the course of a day, this could be a sign of heart damage or disease. So could palpitations that last more than a few seconds or are accompanied by dizziness, shortness of breath or other symptoms. These palpitations should always be checked by a physician (in some cases, on an emergency basis). You might need tests—including blood work and an electrocardiogram (EKG or ECG)—to analyze the heartbeat and identify likely problems. Unusual heart sensations—and what they could mean…

    • Sensation: Skipped beats. What it could be: Premature atrial contractions (PACs), which occur in the heart’s upper chambers, or atria…or premature ventricular contractions (PVCs), which affect the lower chambers, or ventricles. These are the most common types of palpitations—and usually the least serious.

With these palpitations, the heart simply beats earlier than it should.You might feel a “pause” in your heartbeat, followed by a strong “thump” as the heart compensates for the delayed beat.

Most individuals have occasional PVCs. PACs are also common. If you don’t have a history of heart disease (including atherosclerosis), your doctor will probably tell you not to worry. Exception:When PVCs are repetitive, with one following right after the other for seconds or minutes. This pattern increases the risk for a more serious arrhythmia called ventricular tachycardia (see below).

Treatment options: For frequent premature heartbeats, you may need an antiarrhythmic medication. There are many such drugs, including disopyramide (Norpace), propranolol (Inderal) and sotalol (Betapace). Helpful: Cutting back or avoiding alcohol, caffeine, smoking and emotional stress often can reduce the frequency of PVCs and PACs and may prevent the need for medication.

    • Sensation:Racing (as with a very fast pulse) and/or fluttering. What it could be: Atrial fibrillation. It’s a serious arrhythmia that you may or may not feel—and it might occur with sudden sweating or chest pain that feels like a heart attack. It also can cause dizziness, weakness and/or shortness of breath. With atrial fibrillation, the heart’s upper chambers beat too erratically to efficiently pump blood to the lower chambers. Result: Blood pools in the atria and may form clots. Each year, about 8% of people with untreated atrial fibrillation have a stroke.

If you have racing and/or fluttering sensations in your heart, go to a hospital emergency department. If your heart turns out to be healthy, you might have had lone atrial fibrillation, a onetime event that’s unlikely to be dangerous. But if you keep having these sensations, or they last a long time (or never go away), you’re going to need treatment.

Treatment options: If you are experiencing atrial fibrillation, your doctor will try to convert the heartbeat back to a normal rhythm. This can sometimes be done with anti-arrhythmic drugs or with electrical cardioversion, in which an electrical shock is delivered to restore the heart’s normal rhythm.

If this treatment doesn’t work, you might be given a prescription for a beta-blocker, a calcium channel blocker or other drugs that prevent the heart from racing or fluttering, along with blood-thinning medications to prevent clots. You’ll probably need to take the drugs for life. Another approach, known as radiofrequency ablation, uses electricity to permanently damage (ablate) the cells in the heart that are causing abnormal rhythms. This is usually done only when medications and other approaches haven’t helped.

    • Sensation:A sudden burst of rapid beats lasting seconds to hours. What it could be: Ventricular tachycardia (V tach). Get to an emergency department! V tach usually occurs in people with a history of heart disease. The lower chambers of the heart can start beating faster than 170 times a minute. It can lead to ventricular fibrillation, a dangerous arrhythmia that causes the heart to quiver instead of pump. It’s the main cause of sudden cardiac arrest, which is usually fatal.

How can you distinguish a racing heart from V tach? You can’t. You must be treated at a hospital emergency department, particularly if you’re dizzy or have actually lost consciousness—both symptoms of insufficient blood flow.

Treatment options: People with V tach are often treated in an emergency department with antiarrhythmic medications. They might be given a strongelectrical shock to restore the heart’s normal rhythm.

Once the heart has stabilized, you might need long-term care to prevent future attacks. Possibilities: An implantable cardioverter defibrillator (ICD), a surgically implanted device that analyzes the heartbeat and administers shocks to prevent ventricular fibrillation…or radiofrequency ablation, which, as mentioned above, purposely damages the parts of the heart that cause abnormal beats.