Heart Palpitations in Pregnancy

Call 999 if

The NHS gives a short, unambiguous list. Call 999 or go to A&E if you currently have heart palpitations and they do not go away, or you also have any of:

• chest pain
• shortness of breath
• feeling faint or fainting

It adds two practical instructions: do not drive yourself, and bring any medicines you take with you. If you have had those symptoms but they have now stopped, ask your GP surgery for an urgent appointment or contact NHS 111.

The pregnancy-specific version of the same warning sits on the NHS red-flag page: breathlessness that comes on suddenly, breathlessness when you are lying down, or breathlessness with other symptoms such as chest pain or dizziness "needs to be checked immediately". Tommy's makes the same point about breathlessness, adding that ordinary pregnancy breathlessness "should not be painful or come on suddenly".

See a GP, not urgently, if

The NHS lists these as reasons to book rather than to rush: palpitations that keep coming back or happen more often, palpitations lasting longer than a few minutes, having a heart condition, or a family history of heart problems.

What palpitations actually are

The NHS defines them as your heartbeat becoming more noticeable, felt in your chest, neck or throat, and describes the four sensations people report: racing or beating very fast; irregular, with skipped or extra beats (ectopic beats); pounding or thumping; or fluttering. They can last seconds, minutes or longer.

Crucially, it says they are "common and not usually a sign of anything serious", and names pregnancy directly: "Some people get them during pregnancy."

Why pregnancy produces them

Pregnancy asks the heart to move a much larger volume of blood, and it does that by beating both harder and faster. A resting heart rate that is higher than your pre-pregnancy normal is an expected consequence, not a fault, and it is why an ordinary heartbeat becomes a noticeable one.

The NHS list of common causes outside pregnancy explains the rest of the pattern people notice: strenuous exercise, lack of sleep, stress and anxiety, some medicines, and alcohol, caffeine, nicotine and recreational drugs. Lack of sleep and caffeine are the two most modifiable, and both are common companions to late pregnancy.

The anaemia link worth acting on

This is the part most pregnancy articles skip. The NHS names iron deficiency anaemia among the conditions that cause palpitations, and iron deficiency anaemia lists "noticeable heartbeats (heart palpitations)" among its own main symptoms, alongside tiredness and lack of energy, shortness of breath, paler than usual skin and headaches.

It also says plainly that "heavy periods and pregnancy are very common causes of iron deficiency anaemia", and that in pregnancy it is most often caused by a lack of iron in the diet.

That matters because anaemia in pregnancy is picked up on a routine blood test and is treatable. If your palpitations arrive alongside breathlessness and a level of tiredness that sleep does not touch, that combination is worth mentioning at your next appointment rather than filing under normal. The NHS also names an overactive thyroid and heart rhythm problems among other causes.

The anxiety link

The NHS page on anxiety in pregnancy lists "a more noticeable or unusual heartbeat (palpitations)" among the symptoms of perinatal anxiety, together with feeling tense all the time, worrying about your pregnancy constantly, trouble concentrating, difficulty sleeping and feeling faint or dizzy.

This runs both ways, which is what makes it hard. Anxiety produces palpitations; palpitations produce anxiety. Naming it does not make it imaginary — it means the sensible response includes the things that treat anxiety, not only the things that treat hearts.

What helps

The NHS says treatment depends on the cause and that palpitations often do not need treating at all. Where they are not caused by a health condition, it suggests avoiding the triggers: stress, smoking, caffeine and alcohol.

In practice, for pregnancy:

• Cut caffeine and look at when you have it. Late-afternoon caffeine and poor sleep compound each other.
• Protect sleep where you can. Lack of sleep is on the NHS causes list in its own right.
• Notice the pattern. After eating, on standing, at night in bed, or when anxious are all worth recording, because it is the first thing you will be asked.
• Stay hydrated. Dehydration reliably makes palpitations more noticeable.
• Mention them at your antenatal appointment even if they have settled, so anaemia and thyroid can be considered.

What tests you might have

The NHS says you may have an electrocardiogram (ECG), a test where small pads are stuck to your skin to check the electrical signals from your heart, and that you may be referred to a cardiologist for further tests. A blood count to look for anaemia and a thyroid test are the other routine ones. None of that is a sign that something has been found; it is how the common causes get ruled out.

An ECG takes a few minutes, involves no radiation and is safe at any stage of pregnancy. Its limitation is that it records only the moments it is running, so if your palpitations come in short bursts a normal trace does not mean nothing happened. That is why you may be asked to wear a monitor for a day or longer, or to keep a simple diary of when episodes occur and what you were doing.

The short version

Noticeable, racing, fluttering or thumping heartbeats that come and go, and settle on their own, are an ordinary part of a pregnancy that is moving far more blood than usual. Palpitations that do not stop, or that arrive with chest pain, breathlessness or feeling faint, are a 999 call and not a wait-and-see.