Why Do We Get Heart Palpitations?

Why do we get heart palpitations when a heart monitor so often shows a perfectly normal rhythm? Jen, Chris and Matt unpack the science behind one of the most unsettling sensations a healthy person can have. A palpitation isn’t a diagnosis. It’s simply the word for becoming aware of your own heartbeat, and it can come from two very different places: a genuine change in what the heart is doing, or a change in how much attention you’re paying to it. In this episode, the team explores how adrenaline turns up both the speed and the force of each beat, why a “skipped” beat is usually an early one, and why sodium, potassium and magnesium matter for the heart’s electrical signals. They also look at Harvard Health figures on palpitations during perimenopause and after menopause, everyday triggers from caffeine to decongestants, the warning signs that need prompt medical attention, and what the evidence actually supports, from vagal manoeuvres to a two-week trigger diary. In this episode 00:00 Why do we get heart palpitations? 01:20 Two causes, your heart or your awareness 02:38 How adrenaline changes your heartbeat 04:58 The skipped beat that arrives early 07:28 When the rhythm is normal but you still feel it 09:29 Hormones, stimulants and medications 13:04 When to get palpitations checked 15:45 What the evidence actually supports 18:41 So that’s why Why Adrenaline Makes Your Heartbeat Feel Louder (02:38) The most frequent driver of palpitations is the sympathetic nervous system, better known as fight or flight. Anxiety, fear, excitement and fever all trigger the release of stress hormones such as adrenaline. Adrenaline speeds the heart up and increases the force of each contraction, which are two separate effects Your heart rate climbs normally when you jog for a bus, yet almost nobody calls that a palpitation It’s the stronger beat, not the faster one, that people tend to notice Chris: “If you think of your heartbeat as music that’s been playing quietly all day, adrenaline turns up the tempo and the volume at the same time.” The Skipped Beat That Actually Arrives Early (04:58) The skipped beat is the sensation that frightens people most, but there often isn’t a gap at all. Many “skipped” beats are premature contractions, where an early electrical impulse fires ahead of the normal rhythm These are called ectopic beats (“ectopic” means out of place) and they’re extremely common in structurally normal hearts Every heartbeat starts as an electrical signal that relies on minerals such as sodium, potassium and magnesium moving across cell membranes, which is why electrolyte imbalances can set early beats off Chris: “Your heart is basically an overachiever, Matt.” Why a Normal Heart Rhythm Can Still Feel Wrong (07:28) When people wear an ambulatory ECG (a wearable device that records the heart’s electrical activity over hours or days), clinicians frequently find a completely normal rhythm, even during a reported episode. Johns Hopkins University is clear that the sensation is real, even when there’s no rhythm disturbance Perceiving your own heartbeat is a genuine sensory process, and how much attention it receives varies enormously Noticing the beat can trigger alarm, which feeds the very response that makes the beat stronger Jen: “You notice the beat. Noticing it is alarming. Alarm triggers a sympathetic response, and the sympathetic response makes the beat stronger and easier to notice.” When Heart Palpitations Are Worth Getting Checked (13:04) Most palpitations settle on their own, but occasionally they signal an arrhythmia, a genuine electrical malfunction such as atrial fibrillation. Palpitations with chest pain or pressure, breathlessness, dizziness, fainting or unusual sweating need emergency assessment Palpitations that are frequent, getting worse or persistent through the day should prompt an ECG or extended wearable monitoring Monitoring is non-invasive, widely available, and replaces guessing with an answer Matt: “So it’s the company that it keeps rather than the palpitation on its own, and do go.” About So That’s Why So That’s Why is a weekly podcast where Jen, Chris and Matt unpack the science behind everyday health questions. No jargon, no judgment. Just genuine curiosity and proper research. Website: https://www.vegetology.com/so-thats-why-podcast