Heart Attack vs. Heart Palpitations — What’s the Difference?

If you get a sudden discomfort in your chest, you might be left wondering — and worrying — if you could be having an emergency with your heart. A heart attack can cause discomfort in the chest, but it doesn’t usually cause palpitations. Palpitations on their own are often not serious. Where it gets murky is when chest discomfort and palpitations occur together and with other worrying symptoms. 

Here, we’ll try to tease out the differences between the two conditions, where they overlap, and when to see medical attention.        

What are heart palpitations?

Palpitations are an awareness of your heart beating. Some people describe them as a flutter, while others may describe the feeling of a racing or pounding heartbeat. Palpitations are commonly felt in the chest, but it’s also possible to feel your heart pounding in your throat, neck, or even your ear. 

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Mostly, heart palpitations come on out of the blue, last a few seconds or minutes, and then pass. They can come on at any time, whatever you’re doing. 

Our heart rate is not something most of us are aware of. Palpitations occur when our heart rate becomes abnormal enough for us to notice it.

What causes heart palpitations?

Many situations, medical conditions, and triggers can cause palpitations. 

Sometimes, palpitations are a normal response to a situation, such as jitters, fear, and panic or anxiety attacks. It’s also normal to have a faster heart rate if you’re exercising, pregnant, or going through menopause. 

Caffeine, alcohol, smoking, and using recreational drugs can all cause palpitations, too. Medications can cause palpitations as well — common examples are albuterol, a treatment for asthma, and pseudoephedrine, a decongestant.

But there are also more serious causes of heart palpitations:

• An irregular heartbeat (arrhythmia), such as atrial fibrillation

• Hypertrophic cardiomyopathy, a type of genetic disease that causes thickening of the heart muscle

• Heart failure

• Heart valve disease

• Hyperthyroidism, an overactive thyroid gland

• Anemia

Sometimes people describe palpitations as an extra heartbeat. Most people experience occasional extra beats, called premature ventricular contractions or premature atrial contractions, without even noticing them. They are generally not dangerous, though they can be treated with heart medications like beta blockers if they are bothersome.

Can heart palpitations lead to a heart attack? 

Palpitations can technically lead to a heart attack if the heart is racing so fast and for so long that the heart isn’t able to pump properly and becomes starved of blood and oxygen. Most of the time, though, heart attacks are caused by a blockage in the coronary arteries supplying the heart muscle.  

How to know when heart palpitations are a sign of a heart attack

Most heart palpitations are not life threatening, but you should know the clues that could mean you are having a heart attack. 

You may be having a heart attack if you feel chest pain, chest pressure, or chest tightness and:

• Shortness of breath

• Nausea 

• Sweats

In a heart attack, chest discomfort can spread to the shoulders, arms, neck, or jaw as well. These symptoms are not a simple case of palpitations, and you should seek emergency medical help or call 911. 

Can a heart attack cause palpitations?

Though most heart attacks don’t cause palpitations, it is possible. If the electric circuits in the heart are affected in a heart attack, the in-built pacemaker of the heart could become dysregulated, and abnormal heart rhythms could kick in. 

Unfortunately, abnormal heart rhythms that can cause palpitations during a heart attack are very dangerous and often life threatening. Ventricular tachycardia is one of the heart rhythm disturbances associated with heart attacks, and it is responsible for what is known as sudden cardiac death.

Why trust our experts?

Written by:

Khama Ennis, MD, MPH, FACEP

Dr. Ennis is a board-certified emergency physician based in western Massachusetts. She is the medical staff president and associate chief of emergency medicine at Cooley Dickinson Hospital.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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