For patients · Reading time 10 minutes · Version 1.0 · Translation of the German page, medically reviewed on 9 October 2026 · the German version is authoritative · Diese Seite auf Deutsch
Palpitations and a racing heart: what is harmless, what is not, and how to show it to the practice
The heart stumbles, races, skips, and in the consulting room it is as calm as ever. Almost always it is harmless; the exceptions are recognised by certain signs. Here are those signs, the six common pictures to recognise, a pulse check to tap along, the manoeuvre that ends one particular kind of racing, and a log so that the long-term ECG runs at the right time.
The essentials in three sentences
- A racing heart with fainting, chest pain or a diseased heart is an emergency. A skipped beat with a strong thump afterwards in a healthy heart is not.
- Onset, rhythm and duration reveal the cause: abrupt and regular is the light-switch type, completely irregular can be fibrillation, gradual and fitting the situation is palpitations.
- Feel the pulse when it happens, tap along, write it down. That is worth more than any ECG taken when nothing is happening.
1
Signpost: when it is urgent
Fifteen signs, four levels. Tick whatever applies and the page tells you how urgent it is.
Tick whatever applies. If nothing applies, leave everything blank.
No warning sign
Then it is most likely ectopic beats or palpitations, as described below: unpleasant, harmless in a healthy heart. Get in touch if a sign appears or it will not let you go.
Your ticks are neither stored nor sent anywhere.
2
Six pictures: which stumbling heart is it?
Telling them apart by onset, rhythm and duration. For each picture: what helps.
Almost everyone has them, most never feel them. The most common cause of a "stumbling heart".
How to recognise it
- A skipped beat, then a strong thump, as if the heart were catching up
- At rest, in bed in the evening, after eating, after alcohol, when tired
- Usually gone with movement
- Pulse regular in between
- An extra beat comes too early; the pause afterwards is felt as a skip
How long
Seconds, single or in runs, in phases over days to weeks.
What helps
With a healthy heart: nothing, except knowing them. An ECG and once a long-term ECG clarify whether the heart is healthy and how many there are. Only from about a tenth of all beats, that is thousands a day, can the heart muscle suffer; then there is treatment. Sleep, less alcohol and exercise reduce the number.
3
The pulse check: tap along instead of describing
Feel the pulse at the wrist and tap at every beat. The page measures rate and regularity and says which picture it fits.
- Sit down, arm resting, palm up.
- Two fingertips, index and middle finger, on the thumb side of the wrist, just below the base of the hand. Do not use the thumb, it has a pulse of its own.
- Press lightly until you feel the beat. Then, with the other hand, tap the button at every beat for 30 seconds.
– beats per minute
Too few beats yet
Tap along for at least twelve beats, better for 30 seconds.
Smartwatch and ECG watch
The watch's pulse alert is a good hint, not a diagnosis: in the large Apple study with 420,000 participants, 5 in 1,000 received an alert; in 34 out of 100 of those alerted, the later patch ECG found atrial fibrillation, and when alert and patch ran at the same time, 84 out of 100 alerts were correct. The watch's single-lead ECG is worth more: it shows atrial fibrillation reliably when it is there. Save the strip as a PDF and bring it with you. What the watch cannot do: reliably tell ectopic beats from fibrillation, and recognise a dangerous racing heart.
Perez 2019, Apple Heart Study
Tapping measures your feeling, not the heart: if you miss a beat, you create a gap. Measure twice. An ECG is not replaced by this. The times are not stored.
4
The manoeuvre against the light-switch racing
Strain, lie flat, legs up. Only for the abruptly starting, regular racing heart, and only without warning signs. With a clock.
The modified Valsalva manoeuvre
Well establishedOnly for the light-switch type of racing heart: started abruptly, very fast, regular. Not for atrial fibrillation, not with chest pain, fainting or known heart disease; there the emergency number applies.
Appelboam 2015 (REVERT, 433 patients): 43 out of 100 back in normal rhythm, compared with 17 with the old manoeuvre sitting up
Step 1 of 4
Half sitting on a bed or sofa, upper body leaning back at about 45 degrees. Someone should be with you to lift your legs in a moment.
5
Your episode log
One entry per episode: when, how long, how fast, how it started, regular or not, what came with it and before it. The page recognises the pattern and says which recording makes sense at the practice. For printing.
With it
Before it
0
Episodes
0
started abruptly
0
irregular
Your entries stay on this device. They are not sent anywhere. If you clear your browser history, they are gone: print the log before your appointment.
6
What is examined at the practice, and why the ECG is often normal
Five tools, each for a different question.
The ECG at the practice
Twelve leads, ten seconds. Shows the rhythm now, signs of an earlier heart attack and inherited conduction pathways. If the racing heart is not there at the moment, it is often normal, and that is neither an all-clear nor a worry, but the reason for the next steps.
Laboratory
Thyroid, blood count, sodium and potassium, heart markers if needed. An overactive thyroid and anaemia cause palpitations that look like a heart problem.
Long-term ECG
A small device, at our practice as a 24-hour ECG; in general, recordings of up to seven days are possible. It counts ectopic beats and catches episodes that come daily. For rare episodes it is the wrong tool: it has to run at the right time, hence the log.
Event recorder and watch
For rare episodes: a recorder held to the chest during the episode, or the smartwatch's ECG. Both catch exactly the moment that matters.
Ultrasound of the heart
Shows whether the heart muscle and the valves are healthy. That decides whether ectopic beats are harmless, and whether a racing heart can become dangerous. Once done, it is valid for a long time.
7
Two numbers that change something
Out of 100 people, from two studies that concern everyday life.
Valsalva manoeuvre for the light-switch racing
43 out of 100 compared with 17. Back in normal rhythm after one minute: with the modified manoeuvre (strain, then lie flat, legs up) compared with the old manoeuvre sitting up. 433 patients in British emergency departments.
Appelboam 2015, Lancet (REVERT)
Giving up alcohol in atrial fibrillation
53 out of 100 compared with 73. Fibrillation again within six months: in those who went from 17 to 2 drinks a week, compared with those who kept drinking. Plus less than half as much time in fibrillation: 0.5 instead of 1.2 per cent of the time.
Voskoboinik 2020, NEJM, 140 patients
Left: light green is the share that returned to rhythm even without the new method, dark green the gain. Right: light green is those who had fibrillation again despite abstaining, pink the share that abstaining spared.
8
What you can do yourself, and what medicines can do
Ordered by evidence. The strongest lever is not a medicine.
Alcohol: the strongest lever
Well establishedOne drink doubles the likelihood of an atrial fibrillation episode in the next four hours, two drinks triple it. Anyone with atrial fibrillation who cuts alcohol out almost completely gets new episodes clearly less often. Ectopic beats and the stumbling "the night after the party" depend on it too.
Marcus 2021; Voskoboinik 2020
Caffeine: less bad than its reputation
Some studies, small effectIn the study with continuous ECG, coffee caused no additional atrial ectopic beats, but half again as many ventricular ectopic beats, a thousand more steps and 36 minutes less sleep. Anyone who feels stumbling tries two weeks without and sees whether it changes; a ban for everyone is not needed.
Marcus 2023, NEJM (CRAVE)
Sleep, and the breathing pauses at night
Well establishedLack of sleep causes ectopic beats and fibrillation. Anyone who snores, is tired by day and has pauses in breathing at night gets that checked: treated sleep apnoea halves relapses after fibrillation treatment.
Weight and blood pressure
Well establishedIn atrial fibrillation with excess weight: ten per cent less weight reduced the fibrillation burden sixfold in an Australian study. Blood pressure needs controlling; it stretches the atrium.
Pathak 2015 (LEGACY)
Endurance exercise
Well establishedRegular moderate exercise reduces ectopic beats and fibrillation episodes. The page "Exercise and food" has the plan. Only extreme sport over years raises the fibrillation risk again.
Know your own pulse
Well establishedAnyone who knows their resting pulse and their sense of regular and irregular describes in the consulting room what the ECG did not see. The pulse check above practises that.
Breathing against the pounding
Some studies, small effectFour seconds in, six seconds out, for five minutes: slows the pulse and calms the alarm system. In panic the most effective thing you can do immediately. But it does not end a light-switch racing; for that, the manoeuvre.
The medication list
Some studies, small effectAsthma inhalers, cold remedies with decongestants, thyroid hormone, some antidepressants, water tablets through potassium loss: all can cause palpitations or stumbling. Please bring it with you.
Medicines: only through the practice
Nothing is available over the counter
No remedy from the pharmacy ends a rhythm disorder. Magnesium and potassium only help if there is a deficiency in the blood; that is measured, not guessed. Anyone who takes magnesium anyway does themselves no harm, except to the bowel.
Beta blockers
Prescribed for frequent ectopic beats, palpitations and for rate control in fibrillation. They slow the heart and take the force out of the stumbling. Not for everyone; the practice decides.
Blood thinners in atrial fibrillation
The most important building block: they lower the stroke risk by about two thirds. Whether you need them follows from age, blood pressure, diabetes, heart failure and earlier stroke, as a score. The newer medicines need no clotting checks. Not aspirin for this: it hardly protects in fibrillation and bleeds just as much.
Rhythm medicines and ablation
For the light-switch racing and for fibrillation there are medicines that hold the rhythm, and catheter ablation, which cures the light-switch type in over 95 out of 100 and clearly reduces the episodes in fibrillation. That is cardiology, but the decision starts at the practice.
9
From other traditions, and from practice habit
Further reading. Each item says how well it is supported by Western studies.
Hawthorn
Europe
In mild heart failure a small effect on exercise capacity in studies; not studied against a stumbling heart. Harmless, but not the treatment.
Magnesium
Supplements
Sensible with a proven deficiency, otherwise without effect on ectopic beats in studies. Many take it because it does no harm; that is already the whole evidence.
Yoga and breathing exercises
India
In atrial fibrillation fewer episodes and better quality of life in small studies, and with palpitations from tension anyway. Free of side effects.
Cold water on the face
Diving reflex
Face in cold water or an ice pack on forehead and eyes slows the heart via the same nerve as the Valsalva manoeuvre. For the light-switch racing an alternative, in children even the first choice.
Valerian, lavender, lemon balm
Europe
Against the unease the stumbling causes, not against the stumbling. Lavender oil in capsules has a proven small effect in anxiety.
A caffeine ban for everyone
Practice habit
Standard advice for decades, not confirmed in the continuous-ECG study: coffee does not cause atrial ectopic beats. Try it out instead of banning it.
10
Quick check: what will you take away?
Five questions for anyone who likes. No marks.
1. A skipped beat, then a strong thump, in bed in the evening, pulse otherwise regular. What is that usually?
2. Which racing heart does the Valsalva manoeuvre end?
3. What demonstrably reduces the episodes in atrial fibrillation?
4. The smartwatch reports an irregular pulse. What does that mean?
5. A racing heart with fainting. What to do?
No marks, no time pressure. Your progress is kept on this device only.
What this page cannot do
It is for adults and makes no diagnosis. The pulse check measures your feeling, not an ECG; atrial fibrillation is only diagnosed on an ECG. The manoeuvre applies to one particular kind of racing heart and only without warning signs. There is no over-the-counter remedy for rhythm disorders, and whether you need a blood thinner is decided in conversation, not on a web page. This page is a translation of the German original, which is the medically reviewed version; where the two differ, the German text applies.
Version 1.0 · Translation of the German page, medically reviewed on 9 October 2026 · the German version is authoritative
Reviewed by Stefan Höhne, Facharzt für Allgemeinmedizin. Numbers, doses and emergency numbers are identical to the German version and checked automatically. If anything is unclear, the German text applies.
Sources: Appelboam and colleagues, Lancet 2015 (REVERT, modified Valsalva manoeuvre); Marcus and colleagues, NEJM 2023 (CRAVE, coffee) and Ann Intern Med 2021 (alcohol and fibrillation episodes); Voskoboinik and colleagues, NEJM 2020 (alcohol abstinence); Perez and colleagues, NEJM 2019 (Apple Heart Study); Baman and colleagues, Heart Rhythm 2010 (ectopic burden); Pathak and colleagues, JACC 2015 (LEGACY, weight); guidelines of the European Society of Cardiology on atrial fibrillation and supraventricular tachycardia. Medically responsible: Stefan Höhne, specialist in general practice (Facharzt für Allgemeinmedizin). This page is independent: no sponsor, no advertising, no brand names. All patient information (German)