Quick answer. Palpitations are an awareness of your heartbeat – a racing, pounding, fluttering or skipped-beat sensation – and are very common and often harmless, triggered by caffeine, stress or anxiety, exercise, poor sleep, dehydration, alcohol, some medications, fever or thyroid problems. Sometimes, though, they signal an arrhythmia. Atrial fibrillation (AFib) is a common irregular, often fast heart rhythm that becomes more likely with age; it raises the risk of stroke by about 5 times, so it frequently needs blood-thinning (anticoagulant) medication plus rate or rhythm control. It is diagnosed with an ECG and longer Holter or ambulatory monitoring. Call 995 if palpitations come with chest pain, severe breathlessness, fainting or near-fainting; see a GP or cardiologist for frequent, persistent, new or clearly irregular palpitations given the stroke risk.
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Feeling your heart race, pound, flutter or seem to “skip a beat” is one of the most common reasons people in Singapore see a doctor about their heart – and most of the time it is harmless. Palpitations are simply an awareness of your own heartbeat, often set off by everyday triggers like coffee, stress or a poor night’s sleep. Occasionally, however, they are a sign of an abnormal heart rhythm (arrhythmia) such as atrial fibrillation, which matters because it can raise the risk of stroke. This guide explains what palpitations are, what causes them, what AFib is, how both are diagnosed, and – most importantly – when to seek urgent help and when to arrange a check-up.
At a glance
| Cause / type | Typical features | What to do |
|---|---|---|
| Lifestyle triggers (caffeine, alcohol, nicotine, dehydration) | Brief, occasional racing or pounding linked to a clear trigger; settles quickly | Reduce the trigger; usually benign – see a GP if frequent or persistent |
| Stress / anxiety / panic | Racing heart with worry, breathlessness or tingling; often during stressful moments | Stress and breathing techniques; see a doctor if recurrent or to exclude other causes |
| Ectopic (extra/skipped) beats | Single "skipped" or "extra" beat or flutter, then normal; common and mostly harmless | Reassurance; get checked if very frequent or symptomatic |
| Atrial fibrillation (AFib) | Irregular, often fast pulse; may cause breathlessness, fatigue, dizziness – or no symptoms | See a doctor for ECG; AFib raises stroke risk ~5x and may need anticoagulant + rate/rhythm control |
| Thyroid or other medical cause (e.g. hyperthyroidism, fever, anaemia) | Persistent fast heartbeat with weight change, heat intolerance, tremor or tiredness | See a GP for blood tests and treatment of the underlying condition |
| Palpitations with red-flag symptoms | With chest pain, severe breathlessness, fainting or near-fainting | Emergency – call 995 or go to the nearest A&E |
What are palpitations – and why they're usually nothing to fear
Palpitations are the uncomfortable awareness of your own heartbeat. People describe them in different ways – a racing or pounding heart, a fluttering in the chest, or a feeling that the heart has skipped, paused or added an extra beat. They may last seconds or minutes, and can happen at rest or with activity.
In most people, palpitations are benign. Many are caused by ectopic (extra) beats, which the National Heart Centre Singapore describes as common and mostly harmless. The key reassurance is that a brief, isolated flutter with no other symptoms is rarely dangerous. What raises concern is not the sensation itself, but the company it keeps: chest pain, severe breathlessness, dizziness or fainting (see the warning-signs section below).
Common causes and triggers
Most palpitations have an identifiable, non-cardiac trigger. Common ones include:
- Caffeine – coffee, tea, energy drinks and some soft drinks
- Stress, anxiety and panic – stress hormones speed up the heart
- Exercise and exertion – a normal response, but sometimes very noticeable
- Lack of sleep and fatigue
- Dehydration – common in Singapore’s heat and humidity
- Alcohol – especially binge drinking (“holiday heart”)
- Nicotine from smoking or vaping
- Some medications and stimulants – including certain cough/cold remedies and asthma inhalers
- Fever and infection
- An overactive thyroid (hyperthyroidism)
- Hormonal changes – menstruation, pregnancy or menopause
If you can link your palpitations to a clear trigger such as caffeine, anxiety or exertion, they are more likely to be benign. Palpitations that come without warning, recur often, or feel persistently irregular deserve a medical assessment.
What is atrial fibrillation (AFib)?
Atrial fibrillation is the most common sustained heart-rhythm disorder. In AFib, the heart’s upper chambers (the atria) beat in a fast, chaotic, irregular way instead of in a coordinated rhythm, which disrupts how efficiently the heart pumps. It becomes more common with age – in Singapore, about 1.5% of people aged 55 and above have AFib, rising from roughly 0.1% in those under 55 to about 10% in those aged 80 and older, according to HealthHub.
Symptoms can include an irregular or fast pulse, palpitations, breathlessness, fatigue, and dizziness or lightheadedness – but importantly, some people have no symptoms at all and only discover AFib during a routine check, a pulse check, or after a wearable device flags it.
The reason AFib matters so much is stroke. Because blood does not flow smoothly through the fibrillating atria, it can pool and form clots; a clot that breaks off can travel to the brain and cause a stroke. HealthHub and the National Heart Centre Singapore note that AFib increases the risk of stroke by about 5 times. This is why detecting and treating an irregular rhythm is worthwhile even when symptoms are mild.
How palpitations and AFib are diagnosed
The goal of testing is to capture your heart rhythm at the moment you feel symptoms. Common investigations include:
- Electrocardiogram (ECG) – a quick, painless recording of the heart’s electrical activity; the standard first test, ideal if symptoms are present during the recording.
- Holter or ambulatory monitor – a wearable recorder worn for 24-48 hours or longer to catch intermittent rhythm problems that a brief ECG can miss.
- Event or patch monitors – longer-term devices for infrequent episodes.
- Blood tests and echocardiogram – to check for thyroid problems and underlying structural heart conditions.
Consumer wearables such as smartwatches can help flag a possible irregular rhythm and have improved detection of brief episodes – but a wearable alert is a prompt to see a doctor, not a diagnosis. HealthHub cautions that smartwatches may not reliably detect AFib, so any suspected arrhythmia should be confirmed with a medical-grade ECG.
Treatment: protecting against stroke and controlling the rhythm
AFib treatment has two broad aims, alongside addressing any underlying cause:
- Preventing stroke. Because of the raised clot and stroke risk, many people with AFib are prescribed blood-thinning (anticoagulant) medication. Options used in Singapore include warfarin and the direct oral anticoagulants (DOACs) such as apixaban, edoxaban, rivaroxaban and dabigatran; your doctor weighs your individual stroke and bleeding risk to decide if and which anticoagulant is appropriate.
- Controlling the heart rate or rhythm. “Rate control” medications slow a fast heart to ease symptoms, while “rhythm control” (medications, a cardioversion, or a catheter ablation procedure) aims to restore and maintain a normal rhythm.
Lifestyle measures support treatment and can reduce benign palpitations: cut back on caffeine and alcohol, stop smoking, stay well hydrated, manage stress and sleep, and treat underlying conditions such as thyroid disease or high blood pressure. Importantly, do not start or stop any anticoagulant on your own – these decisions should always be made with your doctor.
When to worry: emergencies vs a routine check-up
Call 995 for an ambulance or go to the nearest A&E immediately if palpitations occur with any of these:
- Chest pain or pressure
- Severe breathlessness
- Fainting or near-fainting (feeling you might pass out)
- Profuse, unusual sweating or collapse
Arrange a non-urgent appointment (a GP first, who may refer you to a cardiologist) if you have:
- Palpitations that are frequent, prolonged or recurrent
- A new or persistently irregular heartbeat or pulse
- A known irregular pulse, or a wearable alert suggesting AFib
- Palpitations alongside dizziness, marked fatigue or breathlessness on exertion
- A personal or family history of heart disease, stroke or arrhythmia
Given that AFib can be silent yet meaningfully raise stroke risk, it is always worth getting an irregular rhythm checked – even if you feel otherwise well.
Related guides
- Best Cardiology Clinics in Singapore — our editorial shortlist
- cardiology clinics directory
- High blood pressure (hypertension)
- High cholesterol & statins
- Heart attack warning signs
Sources
- HealthHub (MOH) – Controlling Risk Factor of Stroke: Atrial Fibrillation
- National Heart Centre Singapore (NHCS) – Arrhythmia: Doc, I Can Feel My Heart Pounding, Is This Normal?
- SingHealth – Atrial Fibrillation: Symptoms & Treatments
- Agency for Care Effectiveness (MOH) – Oral Anticoagulation for Atrial Fibrillation
- SingHealth HealthXchange – Heart Palpitations: When Is It Serious?
See also
Related conditions & guides
Related conditions and guides you may find useful:
- Coronary Artery Disease & Angina in Singapore
- Diabetes Complications in Singapore
- Heart Rhythm Disorders (Arrhythmias) in Singapore
- Heart Failure in Singapore
- Heart Screening in Singapore
- Heart Valve Disease in Singapore
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