This really does mean totally different things to different people! For most it is an ‘awareness of the heart’ – a sensation that the heart is fluttering, racing, beating irregularly or more forcefully.
The commonest cause of palpitations is the least worrying – extra heart beats called extra-systoles. We all get these at times and they tend to be more noticeable when we are at rest and in bed at night. They can be very disturbing until you know what they are. They are also very sensitive to certain stimulants like caffeine. Very occasionally – such as when they occur almost every other beat – these extra-systoles need treatment.
An awareness of the heart racing for minutes or even hours – a tachycardia – can be of more concern and usually needs investigating. It is not always easy to ‘catch’ the arrhythmia on an ECG but much easier to plan if treatment is needed if we do. Most patients with palpitations will need a 24 Holter and Echo to be confident there is nothing serious causing them. There are now commercial devises available to patients to catch the heart rhythms when they feel symptoms. If the problem is intermittent an implantable loop recorder will reliably give the answer.