Heart Palpitations: 8 Common Causes and When They Become Dangerous

Your heart thuds after you climb the stairs at New Market. It flutters when you lie down at night. Sometimes it skips, then thumps hard once, like it stumbled and caught itself. Palpitations are one of the most common reasons people visit a cardiologist in Dhaka, and also one of the most misunderstood.

Here is the honest headline: most palpitations are harmless, but a minority are the first warning of a rhythm problem that needs real treatment. The skill is telling them apart, and that starts with knowing the usual suspects.

What a Palpitation Actually Is

A palpitation is simply your awareness of your own heartbeat. Normally the heart’s activity stays below conscious perception. When a beat comes early, comes hard, or races, the sudden change registers. That awareness is a sensation, not automatically a disease. Think of it as your heart’s way of getting your attention. Usually it wants nothing more than a glass of water and an earlier bedtime. Occasionally it genuinely needs a doctor.

Cause 1: Stress and Anxiety

The most common cause we see, especially among students before exams, office workers under deadline pressure, and anyone carrying financial worry. Anxiety releases adrenaline, adrenaline speeds the heart, and the racing heart then feeds the anxiety in a loop that can feel terrifying while being completely benign.

Typical pattern: heart rate climbs smoothly to 100 to 140, palms sweat, breathing shortens, and everything settles within 10 to 20 minutes of calming down.

Cause 2: Caffeine, Tea, Energy Drinks, and Nicotine

Bangladesh runs on cha. Three or four cups a day is unremarkable, add late-night coffee during study sessions, plus cigarettes, and you have a steady drip of stimulants on the heart. Caffeine does not usually cause dangerous rhythms in healthy hearts, but it reliably triggers extra beats (ectopics) in sensitive people. Many patients discover their “skipped beats” vanish within two weeks of cutting back to one cup.

Cause 3: Extra Beats (Ectopic Heartbeats)

An atrial or ventricular ectopic is a beat that fires early from outside the normal pacemaker. You often do not feel the early beat itself; you feel the stronger beat that follows it. People describe it as a flip, a thud, or a missed beat.

Ectopics are extremely common. Most adults have some every day. In a structurally normal heart they are benign, though annoying. Frequent ectopics deserve an echo to confirm the heart muscle is fine, plus checks for triggers like thyroid problems and poor sleep.

Cause 4: Thyroid Overactivity

An overactive thyroid gland turns your metabolism up like a stove burner, and the heart responds with persistent fast rates and tremor and weight loss despite good appetite. Hyperthyroidism is common in Bangladesh, particularly in women, and a simple blood test catches it. This is why any cardiologist evaluating palpitations will order TSH along with the ECG. Treating the thyroid usually settles the heart completely.

Cause 5: Anaemia

Low haemoglobin means less oxygen per unit of blood, so the heart compensates by beating faster. With heavy menstrual periods, dietary iron deficiency, or after dengue, palpitations with fatigue and breathlessness on mild exertion are classic. A full blood count costs little and explains a surprising number of racing hearts.

Cause 6: Fever and Infection

Every degree of fever raises resting heart rate by roughly ten beats per minute. After viral illnesses including dengue and typhoid, palpitations can linger for weeks even after fever resolves. Most settle on their own, but post-viral myocarditis, inflammation of heart muscle, is rare yet real. If palpitations after an illness come with chest pain or breathlessness, get checked promptly.

Cause 7: Dehydration and Low Blood Sugar

Skipping iftar and water through a long summer day, heavy sweating, fasting for tests, or plain not drinking enough all reduce blood volume. The heart compensates with faster, harder beats. Standing up quickly then produces a head-rush flutter. This cause needs water and regular meals, not cardiology.

Cause 8: True Rhythm Disorders

This is the category that matters. Supraventricular tachycardia (SVT) strikes suddenly, often in young people, jumping from 70 to 160 or higher within seconds and stopping just as abruptly. Atrial fibrillation produces an irregularly irregular pulse and carries stroke risk. Ventricular tachycardia is fast and potentially life-threatening, especially where previous heart damage or family history of sudden death exists.

These cannot be diagnosed from memory. They need the rhythm captured on a recording, which is exactly what Holter monitors and pocket ECG devices are for.

Red Flags: When Palpitations Become Dangerous

Seek emergency care immediately if palpitations come with any of these:

• Fainting or near-fainting. A rhythm that drops your blood pressure enough to black out is serious until proven otherwise.
• Chest pain or pressure during the episode.
• Breathlessness at rest or waking gasping.
• Sustained racing above 150 that lasts more than a few minutes and does not stop with rest.
• Family history of sudden cardiac death under 50, or unexplained accidents while driving or swimming.

Also take note of the pulse character during an episode if you safely can. A perfectly regular fast beat points toward SVT or sinus tachycardia. An irregular chaos points toward AFib. That single detail guides testing enormously.

How Doctors Investigate Palpitations

The workup follows a logical ladder:

1. History and physical examination, including feeling the pulse between episodes.
2. Resting ECG, which may show wiring abnormalities, old damage, or baseline clues even when currently quiet.
3. Blood tests: thyroid function, haemoglobin, electrolytes including potassium and magnesium, blood sugar.
4. Echocardiogram to check structure and pumping strength.
5. Extended monitoring with Holter or pocket ECG to capture the actual episode.

Only after this do decisions about medicines, ablation, or in rare high-risk cases implanted protective devices arise. Our guides on pacemaker pricing in Bangladesh and ICD pricing cover those paths transparently.

Simple Steps Worth Trying First

If your palpitations are brief, occasional, and never come with red flags, these low-cost measures resolve many cases:

• Cut caffeine to one cup daily for two weeks and see what changes.
• Fix sleep. Six hours or less multiplies both ectopics and anxiety-driven racing.
• Drink water steadily through the day; pale urine means you are ahead.
• Learn vagal manoeuvres for sudden fast episodes: slow deep breaths held firmly, or blowing into your thumb like a blocked trumpet. These sometimes stop SVT before you reach hospital.
• Keep a symptom log: time, activity, duration, whether the beat felt regular or irregular. Patterns emerge faster than patients expect.

Frequently Asked Questions

Can palpitations stop my heart?

In a structurally normal heart with no red flags, this fear is almost never realised. Dangerous rhythms overwhelmingly occur where there is existing heart disease, severe electrolyte imbalance, or inherited conditions. Testing exists precisely to find the few who need protection.

Are palpitations normal during pregnancy?

Mild palpitations are common as blood volume rises 40 percent. Mention them at antenatal visits; they are usually benign but deserve documentation.

Should I go to hospital during every episode?

No. Go during an episode only if red flags accompany it. Otherwise, record the rhythm with a pocket device and bring the tracing to a cardiologist; that data is worth more than a panic trip.

What is the difference between palpitations and arrhythmia?

Palpitation is the sensation. Arrhythmia is an objectively abnormal rhythm confirmed on recording. One can exist without the other.

Do young people need these tests?

Yes, selectively. SVT commonly begins in the twenties and is highly curable with catheter ablation. Age is not reassurance by itself.

Stop Guessing. Record It.

Months of wondering whether each flutter is harmless drains people more than most diagnoses would. A pocket ECG recording during your next episode replaces guesswork with fact, often within days.

Rhythm Care Ltd specialises in exactly this: capturing the rhythm, explaining it plainly, and treating only what needs treatment. Book via our appointment page and bring your symptom log. Your heart has been trying to tell you something. Let us translate.

*This article is general information, not personal medical advice.*