Almost everyone feels their heart do something strange at some point — a thump, a flutter, a moment where it seems to skip and then catch up. That sensation is a palpitation, and most of the time it is completely harmless. But "most of the time" is not "always," and the reason palpitations generate so much anxiety is that a small fraction of them are the first sign of atrial fibrillation (AFib) — an irregular heart rhythm that materially raises the risk of stroke. This article explains what palpitations actually are, how to tell the benign kind from the kind that needs attention, when to go straight to the emergency room, and — crucially — how doctors in Canada go about diagnosing an intermittent rhythm that has usually stopped by the time you reach a clinic.
If your palpitations come with fainting or near-fainting, chest pain or pressure, or severe breathlessness, this is a medical emergency — call 9-1-1. Do not wait for an appointment. The rest of this article is about the far more common situation where you feel palpitations but are otherwise well.
What a palpitation actually is
A palpitation is simply an awareness of your own heartbeat — the perception that it is too fast, too slow, too hard, or irregular. Your heart beats roughly 100,000 times a day and you normally feel none of it. A palpitation is one of those beats becoming noticeable. That noticing can be triggered by a genuinely abnormal beat, or simply by a normal heart beating forcefully during stress or exercise. The sensation itself does not tell you which — that is what the tests are for.
The most common cause is an ectopic beat (also called a premature beat) — an early beat that arises slightly out of sequence, followed by a small pause and then a more forceful "catch-up" beat. That forceful beat is what most people feel as a skip or a thump. In a structurally normal heart, occasional ectopic beats are extremely common and are not dangerous.
Benign causes — the usual suspects
The large majority of palpitations trace back to something benign and often reversible. Common triggers include:
- Ectopic / premature beats — the skipped-beat sensation, common in healthy hearts.
- Caffeine — coffee, strong tea, energy drinks, and some pre-workout supplements.
- Stress and anxiety — adrenaline makes the heart beat harder and faster; palpitations and anxiety feed each other.
- Exercise and deconditioning — a forceful heartbeat during or just after exertion.
- Hormonal changes and thyroid — an overactive thyroid (hyperthyroidism) is a classic and important cause; palpitations are also common around menstruation, pregnancy, and menopause.
- Anaemia — a low blood count makes the heart work faster to deliver oxygen, which is felt as palpitations, often with fatigue and breathlessness.
- Dehydration and electrolyte shifts — low potassium or magnesium can provoke extra beats.
- Alcohol, nicotine, and some medications — including decongestants and stimulants.
The reassuring pattern is palpitations that are brief, occasional, clearly linked to a trigger, and not accompanied by other symptoms. If you can point to the double espresso or the stressful week, the odds are strongly in your favour.
When palpitations warrant concern
The picture changes when palpitations come with company, or when the rhythm itself is abnormal. Two situations deserve real attention.
Red-flag symptoms — treat as urgent or an emergency
If your palpitations occur together with any of the following, seek emergency care — call 9-1-1:
- Fainting or near-fainting (syncope) — losing consciousness or feeling you are about to.
- Chest pain or pressure — especially if it spreads to the arm, jaw, or back. Our companion guide on chest pain in Canada and when to worry covers this in detail.
- Severe breathlessness — struggling to breathe rather than just feeling short of breath.
These combinations can indicate a dangerous arrhythmia or a heart that is not pumping effectively, and they are not something to investigate at leisure.
An irregularly-irregular fast pulse — possible atrial fibrillation
The other pattern to take seriously, even without the red flags above, is a pulse that is both fast and irregularly irregular — meaning there is no discernible pattern at all to the beats, unlike the single skip of an ectopic. If you feel your pulse and it is chaotic, with no steady rhythm you can tap along to, that is the hallmark of atrial fibrillation. It warrants a prompt ECG to confirm the rhythm, even if you feel otherwise well.
Why AFib matters — the stroke connection
Atrial fibrillation is not, in most people, immediately life-threatening in the way a heart attack is. What makes it important is its link to stroke. In AFib, the upper chambers of the heart quiver instead of contracting cleanly, and blood can pool and form clots. If a clot travels to the brain, it causes a stroke — and AFib-related strokes tend to be more severe.
This is why, once AFib is confirmed, a central decision is whether to start an anticoagulant (a blood thinner) to reduce stroke risk. That decision is guided by a validated risk score called CHA₂DS₂-VASc, which tallies factors such as age, sex, high blood pressure, diabetes, prior stroke, and heart failure. A higher score means higher stroke risk and a stronger case for anticoagulation. If you have been newly diagnosed, our detailed guide on what to do when you are newly diagnosed with AFib in Canada walks through this, and if you are weighing treatment options, see AFib ablation versus medication.
How AFib is diagnosed — the challenge of catching the rhythm
Here is the core difficulty, and the reason so many people bounce between appointments without an answer: you can only diagnose a rhythm problem by recording the heart during an episode. AFib and many palpitations are intermittent — they come and go. By the time you reach the clinic, the episode has often passed, and the heart looks entirely normal. Diagnosis is therefore a game of capturing an event that may only happen for a few minutes a week.
Resting ECG
A standard 12-lead electrocardiogram (ECG) records your heart's electrical activity for a few seconds while you lie still. It is quick, cheap, and definitive if you happen to be in AFib at that moment. Its limitation is exactly that: it captures only the moment you are hooked up. A normal resting ECG does not rule out an intermittent arrhythmia — it only tells you what your heart was doing during those few seconds.
24–48 hour Holter monitor
A Holter monitor is a small continuous ECG recorder you wear for 24 to 48 hours while going about your normal life. It captures every beat over that window, which is far more likely to catch an intermittent episode than a snapshot ECG. If your palpitations happen most days, a Holter is often the tool that finds the answer. In Canada, the wait for a Holter varies by region — often a couple of weeks to a couple of months.
Event and loop recorders
When episodes are less frequent — say, once a week or less — a 48-hour window may miss them. In that case doctors use a longer-term event recorder or loop recorder, worn for weeks and activated when you feel symptoms (some record continuously and let you flag the moment). For very infrequent but concerning episodes, an implantable loop recorder can monitor for months to years. The principle is the same: the longer you record, the better the odds of catching the rhythm.
Consumer wearables — single-lead ECG
Increasingly, smartwatches and handheld devices with a single-lead ECG can record a rhythm strip the instant you feel palpitations. These are not a substitute for a formal diagnosis, but a wearable strip captured during an episode can be genuinely useful evidence — sometimes it is the first thing that puts AFib on the table. If you have one, save the recordings and bring them to your doctor.
What your GP should order
If you are seeing your family doctor about palpitations, a sensible and complete workup includes:
- A resting 12-lead ECG — the baseline, done in the clinic.
- A Holter or event monitor — to capture the rhythm during symptoms; the choice depends on how often your episodes occur.
- Blood work — TSH (thyroid), because an overactive thyroid causes palpitations and can trigger AFib; CBC and ferritin to check for anaemia; and electrolytes.
- A stroke-risk assessment (CHA₂DS₂-VASc) if AFib is found — to decide whether anticoagulation is warranted.
Ask your GP for an ECG plus a Holter or event monitor to capture the rhythm, and blood work including a TSH and a CBC/ferritin. In the meantime, record your episodes — note the time, how long they lasted, how your pulse felt (steady skip vs chaotic), and any triggers. If you have a smartwatch with ECG, save a strip during an episode. That record is often what turns weeks of uncertainty into a clear diagnosis.
A note for South Asian patients
South Asians carry an elevated burden of cardiovascular disease relative to the general Canadian population — developing coronary disease and its risk factors, including high blood pressure and diabetes, earlier and at lower body weight. Because several of those factors also feed into both AFib and its stroke risk, palpitations in a South Asian patient deserve a low threshold for proper investigation rather than reassurance alone. It is worth taking them seriously and getting the rhythm captured.
How a specialist opinion from Ginie Health helps
If you have palpitations — or an ECG, Holter, or blood report you do not fully understand — a cardiologist can tell you a great deal quickly. Through Ginie Health, you upload your results and describe your symptoms, and within 6 hours, for $45 CAD, you receive a written clinical opinion from a cardiologist trained at PGIMER or AIIMS — among the finest medical institutions in the subcontinent. The opinion explains whether your palpitations look benign or point toward AFib, which tests to push your GP for, and — if AFib is on the table — how your stroke risk should be assessed.
It does not replace emergency care or your in-person cardiologist, and it never should for red-flag symptoms. What it does is turn an anxious wait into an informed one, so that every appointment you do have counts. If you would rather talk it through, a live video consultation is available for $75 CAD. No referral is required for either.