Palpitations are the awareness of your own heartbeat: fluttering, pounding, skipped beats or a racing heart. Most are caused by benign extra beats or by a normal heart responding to stress, caffeine, poor sleep, fever or hormonal changes. A cardiologist should be consulted when palpitations come with fainting or near-fainting, chest pain or breathlessness, when they start and stop abruptly and last minutes or longer, when they occur during exercise, or when there is a family history of heart rhythm problems or sudden death.
What people actually feel
The heart beats around a hundred thousand times a day and, most of the time, we are entirely unaware of it. Palpitations are simply the moments when we notice. The sensation varies: a single thud followed by a pause, a fluttering in the chest or throat, a run of fast regular beats, or an irregular, chaotic rhythm. Many people feel them most at night, lying on the left side, when there is nothing else to distract attention.
Describing the sensation precisely helps the cardiologist. Was it regular or irregular? Did it start suddenly, like a switch, or build up gradually? How long did it last, and how did it stop? What were you doing at the time? Tapping out the rhythm on a table during the consultation is often more informative than any adjective.
The common and usually harmless causes
Premature beats, from the upper chambers (atrial ectopics) or lower chambers (ventricular ectopics), are the most frequent cause of “skipped” or “thudding” sensations. Nearly everyone has them; some people feel them. In a structurally normal heart they are benign, although frequent ectopics can be troublesome enough to warrant treatment.
A fast but regular heartbeat that builds up gradually with exertion, anxiety, caffeine, nicotine, alcohol, dehydration, fever, anaemia or an overactive thyroid is sinus tachycardia: a normal heart responding appropriately to a stimulus. Certain medications and supplements, including decongestants, asthma inhalers and some weight-loss or energy products, are common culprits. Hormonal shifts during pregnancy and perimenopause frequently bring palpitations that are unpleasant but not dangerous.
Patterns that deserve a proper look
Some features raise the likelihood of a true arrhythmia, a rhythm disturbance arising from the heart’s electrical system, or of an underlying heart condition, and should prompt a cardiology assessment:
- A fast heartbeat that starts and stops abruptly, like a switch, and lasts minutes to hours. This pattern suggests a supraventricular tachycardia or atrial fibrillation.
- An irregular, chaotic rhythm, particularly in people over sixty or with high blood pressure, diabetes or sleep apnoea, which raises the question of atrial fibrillation.
- Palpitations accompanied by fainting, near-fainting, chest pain or marked breathlessness.
- Palpitations that occur during exercise rather than after it.
- A family history of sudden unexplained death, cardiomyopathy or inherited rhythm disorders.
- Palpitations in someone with a known heart condition, a previous heart attack or a heart murmur.
Atrial fibrillation deserves special mention because it is common, often intermittent, sometimes silent, and a leading preventable cause of stroke. Detecting it and deciding on blood-thinning treatment is one of the most valuable things a cardiology assessment can achieve.
Palpitations with collapse, severe chest pain, or breathlessness at rest are emergencies: call for help or go to the emergency room rather than waiting for a scheduled consultation.
How the cardiologist investigates
The consultation begins with the history described above, a review of medications and stimulants, and a physical examination that includes blood pressure, the heart sounds and signs of thyroid disease or anaemia. A resting ECG is performed. Even if the palpitations are absent at the time, the ECG can show clues: an extra electrical pathway, changes in the heart’s conduction, or signs of structural disease.
Because palpitations are intermittent, the key is to record the heart rhythm during an episode. A Holter monitor records continuously for 24 to 72 hours and suits frequent symptoms. For episodes that occur weekly or monthly, longer event monitors or patch recorders worn for one to two weeks are more useful, and consumer wearables that record a single-lead ECG during a symptom can provide valuable information when the tracing is reviewed by a cardiologist.
Echocardiography, an ultrasound of the heart, assesses the structure and pumping function and is typically arranged when the examination or ECG raises a question, or when the arrhythmia documented needs a structural explanation; it can be performed on site during the same visit. Blood tests for thyroid function, electrolytes and blood count are checked when relevant. An exercise test is used for palpitations that occur with exertion.
What treatment might involve
For benign ectopics and sinus tachycardia, the treatment is usually explanation, reassurance and attention to triggers. Knowing that the heart is structurally normal changes how people experience the symptom. When ectopics remain intrusive, medication can help.
Documented arrhythmias are treated according to type. Supraventricular tachycardias respond to medication or, increasingly, to a curative catheter procedure performed in hospital. Atrial fibrillation involves two separate decisions: controlling the rhythm or rate, and whether anticoagulation is needed to reduce stroke risk, based on a formal risk score. The cardiologist explains the options and coordinates hospital-based procedures where they are needed, while providing the continuity of follow-up in the clinic.
If you have palpitations that concern you and want a thorough, unhurried assessment with ECG and echocardiography available at the same visit, a consultation with a private cardiologist in Modi’in can be arranged within days, without a referral. The information here is general; only a personal assessment can determine the cause of your symptoms.
Frequently asked questions
Are palpitations dangerous?
Most are not. Extra beats and a fast heart responding to stress or stimulants are common and benign. Palpitations that come with fainting, chest pain or breathlessness, that start and stop abruptly, or that occur during exercise should be assessed promptly, and any palpitations with collapse are an emergency.
What should I bring to the cardiology appointment?
Any previous ECGs or heart tests, a list of medications and supplements, and a record of your episodes: when they occur, how they start and stop, how long they last and what you were doing. If your watch or phone recorded an ECG or heart rate during an episode, bring the tracing.
Can anxiety cause palpitations?
Yes, and very commonly. Anxiety raises adrenaline and heart rate and heightens awareness of the heartbeat. The difficulty is that a real arrhythmia can also cause anxiety, so the cardiologist documents the rhythm during an episode before attributing symptoms to anxiety alone.
Do I need a referral for a private cardiology consultation in Israel?
No. Private specialist consultations do not require a referral or Form 17, and they are reimbursable under most supplementary health-fund plans and private policies, subject to policy terms. Ambulatory monitoring and echocardiography can be arranged as part of the assessment.