Palpitations

Seek same-day assessment if palpitations occur with fainting, near-fainting, chest pain, or breathlessness. Palpitations during exercise, or in anyone with known heart disease or a prior cardiac event, also require prompt evaluation. These patterns may indicate a serious arrhythmia that needs investigation before any other approach is considered.

Standard investigation includes a 12-lead ECG, Holter or event monitoring for infrequent symptoms, thyroid function, electrolytes, and blood count. Benign ectopic beats typically need only reassurance and lifestyle adjustment. Atrial fibrillation, SVT, and other arrhythmias have clear evidence-based management pathways including medication and, where appropriate, ablation.

Caffeine, decongestants, and recreational stimulants should be minimised or avoided when palpitations are present. Using herbal cardiac agents without a prior ECG assessment is not appropriate for unexplained palpitations. Slow breathing and vagal manoeuvres have evidence support for certain arrhythmias, but should not replace professional assessment of the underlying cause.

Clinicians assess palpitations by considering associated symptoms, personal and family cardiac history, and ECG findings. Benign causes — ectopic beats, sinus tachycardia from anxiety or caffeine — are common in primary care. Paroxysmal atrial fibrillation and SVT may require longer monitoring to capture, as they can be absent at the time of a standard ECG.

TCM interprets palpitations as disturbances of heart qi or shen; Ayurveda may attribute them to pitta imbalance. European herbal traditions have used hawthorn, motherwort, and lemon balm for heart-calming effects. Naturopathic practice commonly investigates magnesium status. These approaches may complement conventional care but are not a substitute for professional cardiac assessment.

A GP or cardiologist should be the first point of contact for new or unexplained palpitations, particularly if they are frequent, prolonged, or associated with other symptoms. Once a serious cause has been excluded, complementary or holistic approaches may be explored alongside conventional care. Always inform all practitioners of any supplements or herbal products being used.