Almost everyone feels their heart do something strange now and then — a flip, a flutter, a skipped beat, a sudden run of pounding. As an electrophysiologist, palpitations are one of the most common reasons people come to me, and the very first thing I try to do is sort the worried well from the genuinely concerning. Most palpitations are benign. Some are not. Knowing which is which is what lets you stop fearing your own heartbeat.
The most common culprits are completely harmless: premature beats. A premature atrial or ventricular contraction — a PAC or PVC — is an early beat followed by a slightly longer pause, and your heart’s next, more forceful beat is what you actually feel as the “thump.” In a structurally normal heart, occasional premature beats are a nuisance, not a danger. They’re often provoked by the usual suspects: too little sleep, too much caffeine or alcohol, stress, dehydration, or low electrolytes like magnesium and potassium. Fix the trigger and the palpitations frequently settle on their own.
So when should you actually worry? The features that make me pay closer attention are palpitations that come with chest pain, fainting or near-fainting, severe shortness of breath, or that strike during exertion. A fast, regular, sustained racing that starts and stops abruptly can signal a true arrhythmia worth capturing on a monitor. A history of heart disease raises the stakes. And a completely irregular, chaotic pulse can be atrial fibrillation, which needs proper evaluation because of its stroke risk. Any of those deserve a call to your doctor rather than watchful waiting.
For the far larger group with benign palpitations, the root-cause approach works beautifully: protect your sleep, ease off caffeine and alcohol if they’re triggers, stay well hydrated, keep your magnesium and potassium in a healthy range through food, and build in real stress recovery. None of this replaces a proper evaluation when the warning signs are present — but for most people, calming palpitations is less about a prescription and more about removing what’s irritating an otherwise healthy heart.
This article is for general education and is not medical advice. New, frequent, or concerning palpitations should be evaluated by a qualified physician.
About the author
Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist with more than 20 years of experience. He works as a consultant helping patients take a natural, root-cause approach to heart health — through diet, lifestyle, and supplements — and sees patients via telehealth through Natural Heart Doctor. His expert commentary has been featured in Medscape and Men’s Journal. Learn more at andrewrudin.com. Work with Dr. Rudin at Natural Heart Doctor →