Private palpitations clinic in London, same-day cardiology.

The common, harmless kind

Extra beats — ectopics — are felt as a missed beat followed by a thump. They are extremely common, occur in healthy hearts, and are typically noticed most when you are still, in bed or stressed. Paradoxically they often reduce during exercise, which is reassuring.

• caffeine, energy drinks and excessive tea or coffee
• alcohol, particularly binge drinking — sometimes called holiday heart
• nicotine, cannabis, cocaine and stimulants
• stress, anxiety and poor sleep
• dehydration, missed meals and low potassium or magnesium
• decongestants, salbutamol inhalers, thyroid medicine and some antidepressants
• fever, anaemia, an overactive thyroid, and the menopause

Atrial fibrillation

AF is an irregular, often fast heart rhythm. It may cause palpitations, breathlessness or fatigue — or no symptoms at all. It matters because it substantially increases the risk of stroke, and because that risk is largely preventable with anticoagulation.

• Check your own pulse: feel at the wrist for 30 seconds. AF is irregularly irregular — no pattern at all to the gaps.
• Many smartwatches and phone devices detect AF reasonably well. A notification is worth acting on, though it needs confirming with a proper ECG.
• AF becomes more common with age, high blood pressure, alcohol, sleep apnoea, thyroid disease and being overweight.
• If AF is confirmed, the two questions are rate or rhythm control, and whether you need anticoagulation to prevent stroke. The second is the one that changes lives.

Slowing a fast regular palpitation

Some fast regular rhythms respond to manoeuvres that stimulate the vagus nerve. If you have been shown these and told they are appropriate for you: bear down as if straining, or blow hard against a closed mouth and pinched nose for 15 seconds. Do not press on your neck or eyes. If the episode does not stop within a few minutes, or you feel unwell, call for help.

Reducing episodes

• Cut caffeine substantially for two weeks and see whether it changes anything — a genuine test rather than a vague reduction.
• Reduce alcohol; it is a far more common trigger than people expect.
• Address sleep, including snoring and daytime sleepiness, which may indicate sleep apnoea.
• Regular aerobic exercise reduces ectopics in most people.
• Have thyroid function and a full blood count checked — anaemia and thyroid problems are easily missed causes.