What speeds up the heartbeat and what can you do to reduce arrhythmia?

According to AFib Matters (the ESC and EHRA patient website), feeling your heartbeat, that is, palpitations, means that you notice your own heartbeats. The heart may seem to beat harder or faster, or irregularly, and beats may seem to drop out. Less often, a very fast “fluttering” is felt.

The list of causes includes the usual state after exercise, excitement or an infection, extra (ectopic) beats, other arrhythmias, anxiety, caffeine and other conditions not related to the heart. This sensation may come and go. So feeling your heartbeat is not always a sign of disease, but if it keeps coming back or bothers you, you need to get checked. Only tests show what the cause is in your particular case.

AFib Matters names alcohol and caffeine as possible triggers and includes anxiety among the causes that make you feel your heartbeat. “Possible” means: not in everyone and not every time.

The ESC sources cited in this article give no limit at all for caffeine, so there is no “how many cups a day” figure. A more useful approach is to keep a diary of the situations in which you feel your heartbeat and discuss it with your doctor.

For alcohol, however, there is a figure: to reduce recurrences of fibrillation, the 2024 ESC/EACTS guidelines recommend limiting alcohol to at most 3 standard drinks a week, that is, 30 g of pure alcohol. This figure comes from the guidelines on atrial fibrillation and is not a general rule for everyone.

According to a review of the 2024 ESC/EACTS guidelines (Rienstra and co-authors, Europace 2024), the following risk factors should be assessed and managed:

• high blood pressure;
• heart failure;
• diabetes mellitus;
• obesity;
• pauses in breathing during sleep (obstructive apnea);
• low physical activity;
• drinking large amounts of alcohol.

Having a risk factor does not mean that fibrillation will inevitably develop, but paying attention to these factors is recommended. Managing them is done together with your doctor: do not change your blood pressure or blood sugar medicines on your own. Blood pressure targets and medicine doses are not given in this article; your doctor sets them.

For people with fibrillation who are overweight or obese, the guidelines name a loss of at least 10 % of body weight. For physical activity, a tailored exercise program is recommended. To prevent fibrillation, 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic activity a week are mentioned.

These figures come from the guidelines on fibrillation and are not a rule for everyone. The article does not give advice on diets or supplements: agree on your weight plan and your level of exercise with your doctor, especially if you have heart symptoms.

Pauses in breathing during sleep (obstructive sleep apnea) are among the risk factors for fibrillation. According to the 2024 ESC/EACTS guidelines, using questionnaires alone to detect sleep apnea is not recommended. In other words, the result of a questionnaire is not enough on its own. If you suspect it, tell your doctor; they decide which test is needed.

According to AFib Matters, if you often feel your heartbeat, especially with dizziness, chest pain or shortness of breath, see a doctor. Do not put off seeing a doctor about fast and distressing episodes. Until your appointment, keep a symptom diary: duration, triggers and accompanying symptoms.

For a clear conclusion about the rhythm, the most important thing is an ECG recording taken during the symptoms. Feeling your pulse may raise a suspicion of irregularity, but it cannot reliably confirm it.