Heart Palpitations

What is Heart Palpitations?

Palpitations are a feeling that the heart is racing, fluttering, pounding or skipping beats, and some people feel a pounding sensation in the neck. They are common, and the death rate associated with them is low, but recurring palpitations can lower quality of life and increase use of health care.^[1]

Common symptoms

People describe palpitations in different ways, and they may last seconds or longer.^[1]

• A racing or fluttering heart
• A pounding chest or neck
• Skipped or irregular beats
• Fatigue or fainting with the palpitations, which may point to an arrhythmia and should be reported to a physician^[2]

Causes and risk factors

Common triggers include heart rhythm disorders and other cardiac conditions, endocrine and metabolic problems, medicines or drugs, and psychological causes.^[1] An overactive thyroid is one example: palpitations are among its common symptoms, and untreated hyperthyroidism can cause arrhythmias.^[3] Anxiety disorders are also associated with physical symptoms such as palpitations.^[4]

Atrial fibrillation and atrial flutter are among the most common heart rhythm disorders that can cause palpitations.^[2] Palpitations are also common in the menopause transition.^[5]

How it is diagnosed and treated conventionally

Everyone with palpitations should have a detailed history, physical examination and an electrocardiogram (ECG), which alone can often point to a probable cause.^[6] Further tests may include blood tests, ambulatory ECG monitoring, echocardiography, stress testing or referral to a cardiologist.^{[1, 6]}

Treatment depends on the cause. It may include reassurance, education and trigger avoidance, or medicines that slow conduction through the heart, and some fast rhythms may need cardiac ablation. People with no heart disease and no rhythm problem are reassured, and screening for psychological causes may be considered.^[1]

Why Heart Palpitations calls for a whole-person approach

Palpitations are a symptom with many possible sources, so more than one factor often matters. The heart, the thyroid, medicines, stress and anxiety, and hormones can each play a part.^[1]

Because of this, a physician's evaluation comes first, and complementary care is added around it. Care that addresses stress, sleep and general health can be a reasonable addition once serious causes have been ruled out.

The heart rhythm itself

Rhythm disorders such as atrial fibrillation or flutter are common causes, and a physician looks for them with an ECG and sometimes a monitor.^{[2, 6]}

Thyroid and other medical conditions

Endocrine and metabolic disorders, including an overactive thyroid, are recognized triggers and are checked with blood tests.^{[1, 3]}

Stress and anxiety

Anxiety disorders commonly include palpitations among their physical symptoms, and when no arrhythmia is found, screening for psychosomatic causes may be considered.^{[1, 4]}

Hormonal change

Palpitations are reported by many women during the menopause transition, but a systematic review found few treatments studied specifically for them.^[5]

Medicines and substances

Medication or drug use is a common trigger, so a review of everything you take, including supplements, is part of a proper evaluation.^[1]

Acupuncture for Heart Palpitations

What the research shows

The research is limited. Most studies look at specific rhythm problems such as premature beats and atrial fibrillation, not palpitations as a general symptom, and they do not replace a cardiology evaluation.

A 2022 systematic review of 9 trials (847 participants) of acupuncture for premature ventricular complexes in people without structural heart disease pooled two sham-controlled trials with low risk of bias and found that acupuncture significantly reduced the number of premature beats. Acupuncture added to standard treatment also did better than standard treatment alone. The authors rated the certainty of the sham-controlled evidence as moderate and called for better outcome measures.^[7]

For atrial fibrillation, a 2024 meta-analysis of 15 trials (1,960 patients) reported more conversion to sinus rhythm and a lower ventricular rate with acupuncture, but noted that a limited number of studies may affect how far the findings apply.^[8] A small sham-controlled trial of 80 patients found fewer recurrences after cardioversion with acupuncture than with sham.^[9] Another trial of 85 patients found that acupuncture at the Neiguan point added to amiodarone lowered early recurrence after ablation.^[10]

Broader reviews are more cautious. A 2018 review of 9 trials (638 patients) found only one with low risk of bias and said no robust conclusion was possible.^[11] An overview of 10 systematic reviews rated their methodological quality as very low and most evidence as low or very low quality, while concluding that acupuncture is clinically effective as an adjunct.^[12] A meta-analysis of 11 trials found acupuncture plus Chinese herbal medicine did better than the herbal medicine alone, with no clear rise in adverse events.^[13]

How acupuncture may work

For premature beats, experiments in animals found that electroacupuncture reduced sympathetic nerve activity.^[7] In one trial, acupuncture after ablation was linked with lower levels of inflammatory markers.^[10] These are proposed explanations from animal and small clinical studies, not established mechanisms in people.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the wrists, forearms, hands, chest and legs, usually left in place for about 20 to 40 minutes. The trials in premature beats mostly used a 4-week course with needles retained for 15 to 30 minutes.^[7] We reassess after a short course of visits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker or other implanted heart device (relevant to electroacupuncture).

Ayurvedic medicine for Heart Palpitations

The Ayurvedic view

In Ayurveda, a fluttering or racing heartbeat is traditionally described as a Vata disturbance affecting the heart, sometimes with Pitta or with anxiety and poor sleep. The heart is considered a seat of vitality, and the word hridaya is used for it. These are traditional frameworks used to choose care, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally may combine:

• Regular meals, steady sleep, and reducing stimulants such as caffeine, which fits with the trigger avoidance used in conventional care^[1]
• Gentle warm oil massage
• Breathing and relaxation practices
• Herbs selected by the practitioner, from tested sources

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty, and should not be started until the cause of palpitations has been medically assessed.

What the research shows

We found no clinical trials of Ayurvedic medicine or Panchakarma for palpitations or arrhythmia, so the evidence for the condition is none. Mind-body practices such as yoga have been studied in arrhythmia, but they are not part of Ayurvedic treatment as such, and we do not cite them as evidence for it. Because about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic in one study, product quality matters.^[15]

Herbal medicine for Heart Palpitations

Herbs and formulas that have been studied

Most research is on Chinese patent formulas used for arrhythmia in China, mainly Wenxin Keli for premature ventricular beats and Shensong Yangxin capsule for atrial fibrillation.^{[16, 17, 18]} These are standardized commercial products and are not the same as an individually prescribed formula.

What the research shows

The evidence is limited. A systematic review of 10 trials found that Wenxin Keli might work better than placebo for premature ventricular beats and might add to amiodarone, but the trials were generally of low quality, small and short, and showed signs of publication bias.^[16]

A systematic review of 22 trials of Shensong Yangxin capsule in paroxysmal atrial fibrillation found some benefit when added to routine treatment, but quality was generally poor and no firm conclusion was possible.^[17] A 2024 placebo-controlled trial of 920 patients with persistent atrial fibrillation in China found fewer recurrent atrial tachyarrhythmias over 12 months with Shensong Yangxin after catheter ablation, with no significant difference in serious adverse events.^[18] It was conducted only in China and in people who had had an ablation, so it does not show that herbs help everyday palpitations.

Safety and herb-drug interactions

Herbs are active substances and can affect the heart. Aconite roots, used in Chinese medicine only after processing, contain cardiotoxic alkaloids, and poisoning from inadequate processing or excess dose can cause serious arrhythmias.^[19] Reviews also describe interactions between herbs and prescribed drugs, including blood thinners and heart medicines.^[20]

If you take anti-arrhythmic drugs, beta-blockers, digoxin or blood thinners, we need to know before any herb is considered. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease. Herbs should come from tested sources, because some Ayurvedic products contain lead, mercury or arsenic.^[15]

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. In Chinese medicine, palpitations are classically linked to the heart losing its nourishment or calm, described as heart qi, blood or yin deficiency, or as disturbance of the spirit. Acupuncture at the Neiguan (PC6) point is traditionally used for it.^[9] Researchers studying acupuncture look at related measurable ideas such as sympathetic nerve activity and inflammation.^{[7, 10]}

Ayurveda's aggravated Vata, the principle of movement, loosely parallels the erratic rhythm and the nervous system arousal that can accompany palpitations, but no study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Complementary care for palpitations works alongside your physician or cardiologist and does not replace them. We do not diagnose the cause of palpitations or manage heart rhythm disorders, and we do not prescribe or change prescription drugs. Do not stop or change heart medicines, blood thinners or other prescriptions without your prescriber.

Please bring your diagnosis, recent ECG or monitor results, thyroid and blood test results, a full list of medicines and supplements, and a note of your caffeine and alcohol use. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

When to seek urgent medical care

Palpitations are usually not dangerous, but some symptoms with them need immediate attention.

• Chest pain or pressure
• Fainting or near-fainting
• Severe shortness of breath
• A very fast, pounding heartbeat that does not settle
• Palpitations with confusion, weakness on one side, or trouble speaking
• Palpitations in someone with known heart disease that are new or worse

If any of these occur, call 911 or go to the nearest emergency department.