Heart Palpitations in Singapore: Causes and When to Worry

Heart palpitations are an awareness of your own heartbeat – a fluttering, pounding, racing or skipping sensation in the chest. They are one of the most common reasons people see a cardiologist in Singapore, and the reassuring news is that most palpitations turn out to be harmless. Sometimes, though, they are the first sign of a heart arrhythmia (an abnormal heart rhythm) that needs treatment. This page explains what palpitations feel like, their common causes – including after eating, with caffeine, under stress and at night – the red flags to know, and how they are investigated. It is general information and not a substitute for advice from your own doctor.

What Do Heart Palpitations Feel Like?

People describe palpitations in many ways:

• A fluttering or “butterflies” sensation in the chest
• A pounding or forceful heartbeat
• A racing heartbeat, regular or irregular
• Skipped beats, or a single heavy thud or “flip-flop”
• A throbbing felt in the throat or neck

Episodes may last seconds or continue for minutes to hours. Noting how they start and stop, how fast and how regular your pulse feels, and what you were doing at the time gives your doctor valuable clues about the cause.

Common Causes of Heart Palpitations

Most palpitations come from everyday triggers rather than heart disease:

• Caffeine – kopi, teh, energy drinks and some pre-workout supplements
• Stress, anxiety and panic attacks
• Vigorous exercise or lack of sleep
• Alcohol and nicotine
• Fever and acute illness
• Hormonal changes in pregnancy, around periods or during menopause
• Some medications, including decongestants, asthma inhalers and thyroid medication
• Low blood sugar, dehydration, anaemia (a low red blood cell count) and an overactive thyroid

Palpitations can also come from the heart’s rhythm itself. Ectopic beats (early extra beats) are extremely common and usually harmless. Sustained causes include atrial fibrillation, which produces an irregular and often rapid pulse, and supraventricular tachycardia (SVT), which causes sudden bursts of a racing heartbeat.

Palpitations After Eating, With Caffeine, Under Stress and at Night

Certain patterns come up again and again in clinic:

• After eating. A large or rich meal diverts blood towards digestion and can make the heartbeat more noticeable. Caffeine or alcohol with the meal and very heavy, salty hawker meals are common contributors. Occasional palpitations after eating are usually benign, but frequent or prolonged ones deserve a check.
• With caffeine or stimulants. Caffeine increases adrenaline-like activity and can trigger extra beats, especially with poor sleep. Cutting back is often all that is needed.
• Under stress. Adrenaline from stress or anxiety speeds the heart and makes normal beats feel stronger. Anxiety can both cause palpitations and make you hyper-aware of a normal heartbeat – tests can tell these apart.
• At night. Lying quietly, particularly on your left side, makes the heartbeat easier to feel, so many “night palpitations” are simply increased awareness. However, palpitations that wake you from sleep, or occur with breathlessness, deserve assessment – night-time episodes can occasionally be the first sign of atrial fibrillation or sleep apnoea.

When to Seek Emergency Help

Call 995 if palpitations occur together with:

• Chest pain or pressure
• Fainting or collapse
• Severe breathlessness
• Sudden face drooping, arm weakness or slurred speech

You should also see a doctor promptly – even without emergency features – if palpitations come with near-fainting, happen during exercise, are prolonged with a very fast pulse, or if you have known heart disease or a family history of sudden unexplained death.

How Palpitations Are Investigated

Diagnosis starts with a careful history, an examination and an electrocardiogram (ECG), which records the heart’s electrical activity over a few seconds. Because palpitations often come and go, further tests are frequently needed:

• A 24-hour Holter monitor – a small wearable recorder that captures every heartbeat over a day or more; our Holter monitor test guide explains exactly what wearing one involves
• Longer wearable or event recorders when episodes are infrequent
• An echocardiogram (ultrasound scan of the heart) if a structural problem is suspected
• Blood tests for thyroid function, anaemia and electrolytes (blood minerals)

Keeping a simple symptom diary – what you felt, when, and what you were doing – makes any recording far easier to interpret.

Treatment: What Happens After Diagnosis

Treatment depends entirely on the cause:

• If the heart rhythm is normal, reassurance plus trigger management – less caffeine and alcohol, better sleep, stress management – is often enough
• Underlying conditions such as thyroid disease or anaemia are treated directly
• If an arrhythmia is found, options range from medication (such as beta-blockers, which blunt the effect of adrenaline on the heart) to catheter ablation, a keyhole procedure that can treat conditions such as SVT at their source
• Where anxiety is a major driver, addressing it directly often improves symptoms considerably

When to See a Cardiologist

See a cardiologist if palpitations are frequent, prolonged or worsening, if your pulse feels irregular or very fast during episodes, or if palpitations come with dizziness, breathlessness or reduced stamina. A short set of targeted tests can usually establish whether the cause is harmless or needs treatment.

Frequently Asked Questions

When should I worry about heart palpitations?

Seek urgent help if palpitations come with chest pain, fainting or severe breathlessness. Otherwise, see a doctor if they are frequent, prolonged, clearly irregular, occur during exercise, or you have existing heart disease.

Why do I get palpitations after eating?

Digestion diverts blood flow and large meals, caffeine, alcohol and salty food can all make the heartbeat faster or more noticeable. Occasional episodes are usually harmless, but regular ones after meals are worth investigating.

Why does my heart race at night?

Lying still in a quiet room makes your heartbeat easier to notice, and lying on the left side brings the heart closer to the chest wall. Palpitations that wake you up, however, should be checked, as arrhythmias such as atrial fibrillation can present at night.

Can anxiety cause heart palpitations?

Yes – adrenaline released during stress and anxiety genuinely speeds the heart, and anxiety also heightens awareness of normal beats. Because arrhythmias can also cause anxiety, a recording during symptoms is the reliable way to distinguish the two.

Do palpitations mean something is wrong with my heart?

Usually not – most palpitations occur in structurally normal hearts and are triggered by caffeine, stress, poor sleep or hormones. A minority reflect an arrhythmia, which is why persistent or symptomatic palpitations deserve proper assessment rather than guesswork.