Palpitations and Heart Symptoms - What Is Harmless, What Is Not and How to Find Out Quickly
The Wellness is the best place in London to have palpitations investigated, because the answer depends almost entirely on catching the rhythm while it is happening and on excluding the causes that are found in a blood tube. Most palpitations are benign, and ectopic beats, sinus tachycardia from caffeine, alcohol, stress, dehydration or poor sleep account for the large majority. The important minority is atrial fibrillation, which affects an estimated 1.6 million diagnosed people in the UK with many more undiagnosed, becomes far commoner with age, and raises stroke risk around 5-fold when untreated. AF causes roughly 1 in 5 of all strokes, and those strokes are more severe and more often fatal than others, which is why finding it matters so much more than the symptom itself suggests. The causes routinely missed are equally worth knowing. An overactive thyroid produces palpitations, tremor and weight loss and is diagnosed on a blood test. Iron deficiency anaemia produces palpitations, breathlessness and fatigue while the full blood count can still read normal if only haemoglobin is checked. Electrolyte disturbance, alcohol, stimulants, decongestants and thyroid medication all contribute. You are assessed, an ECG and where needed prolonged rhythm monitoring are arranged, bloods go to an accredited laboratory, and echocardiography is arranged at a specialist centre with consultant reporting where the picture warrants it. Consultations from £150 by video and £220 in person. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated August 2026.
Get palpitations assessed on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
When are palpitations dangerous
Palpitations with chest pain, severe breathlessness, or a feeling of impending collapse need an emergency department or 999 now, not an appointment. So does any blackout or near-blackout occurring during palpitations, because loss of consciousness with an abnormal rhythm is the combination that signals a dangerous arrhythmia.
A family history of sudden cardiac death under 40, or of inherited cardiac conditions including hypertrophic cardiomyopathy or long QT syndrome, changes the urgency of any palpitation entirely and warrants prompt cardiology assessment. Palpitations occurring during exertion rather than at rest are more concerning than those occurring at rest, and palpitations in anyone with known structural heart disease or previous heart attack need assessing rather than watching.
An irregularly irregular pulse that you or a device can feel, particularly if sustained, raises atrial fibrillation and should be confirmed with an ECG promptly, because the treatment decision that follows is about stroke prevention rather than symptom relief.
What causes palpitations
Ectopic beats are the commonest explanation by a wide margin. Extra beats from the atria or ventricles produce a thump, a skipped beat or a flutter, they are found in most healthy people, and they are usually harmless. They are worse with caffeine, alcohol, poor sleep, stress and dehydration, and better when those are addressed, which is why a fortnight of change frequently answers the question without any test.
Atrial fibrillation is the one that matters. It produces an irregular, often rapid heartbeat, sometimes with breathlessness or fatigue, and in a meaningful proportion of people it causes no symptoms at all, which is why it is frequently found incidentally. Supraventricular tachycardia produces sudden-onset, sudden-offset rapid regular palpitations, often in younger people, and is treatable and usually curable.
The non-cardiac causes are the ones most often missed. Hyperthyroidism, where palpitations sit alongside tremor, heat intolerance, weight loss and anxiety, and which is confirmed on TSH and free T4. Anaemia, particularly iron deficiency, which produces palpitations, breathlessness on stairs and fatigue and which needs ferritin rather than haemoglobin alone to detect reliably. Electrolyte disturbance, especially low potassium or magnesium. Anxiety and panic, which are real causes and should be diagnosed positively rather than by exclusion. And medication and stimulants, including salbutamol, decongestants, thyroid replacement at too high a dose, and caffeine in quantities people underestimate.
Ask what your symptoms suggest on WhatsApp or email team@thewellnesslondon.com.
How are palpitations investigated
A resting ECG is the starting point and its limitation is obvious. It records around 10 seconds, so unless you happen to be having palpitations at that moment it usually looks normal, which is why so many people leave an appointment reassured and none the wiser. It still matters, because it detects AF present at the time, conduction abnormalities, evidence of previous heart attack and the intervals that indicate an inherited rhythm disorder.
Prolonged monitoring is what catches intermittent symptoms. A 24-hour or 48-hour Holter monitor suits daily or near-daily symptoms. A 7-day or 14-day monitor suits weekly ones. An event or patch recorder, worn for longer with a button to press when symptoms occur, suits infrequent episodes, and an implantable loop recorder is arranged through cardiology for rare but serious events. The rule is straightforward. Match the monitoring duration to how often the symptoms happen, because a 24-hour tape on someone with monthly palpitations answers nothing and is ordered constantly.
Bloods at an accredited laboratory covering full blood count, ferritin and iron studies, thyroid function, kidney function and electrolytes including magnesium, glucose and, where breathlessness features, BNP. Echocardiography is arranged at a specialist centre with consultant reporting where there is a murmur, breathlessness, an abnormal ECG, a family history or a confirmed arrhythmia, because it assesses the structure and function that the rhythm sits on.
What happens if atrial fibrillation is found
The first question is not the rhythm, it is stroke risk. AF raises stroke risk around 5-fold and causes roughly 1 in 5 strokes, and anticoagulation reduces that risk substantially. The decision uses the CHA2DS2-VASc score, which weighs age, sex, heart failure, hypertension, diabetes, previous stroke and vascular disease, alongside a bleeding risk assessment. For most people with a raised score, a direct oral anticoagulant is now preferred to warfarin. Aspirin is not adequate stroke prevention in AF, which remains a widely held misconception.
The second question is rate and rhythm. Controlling the heart rate with a beta blocker or rate-limiting calcium channel blocker relieves symptoms in most people. Restoring normal rhythm, with medication, cardioversion or ablation, is considered where symptoms persist despite rate control, in younger people, and where AF is recent in onset, and that decision belongs with a cardiologist.
The third is the drivers. Hypertension, alcohol, obesity, obstructive sleep apnoea and thyroid disease all provoke and sustain AF, and treating them reduces recurrence meaningfully. Sleep apnoea in particular is under-recognised in people with AF and is investigated here with a home sleep study rather than assumed absent.
What does cardiac assessment cost in London
Consultant cardiology appointments in the Harley Street district run £250 to £500 before any test, with echocardiography, monitoring and follow-ups charged separately. Private echocardiography commonly runs £400 to £900, 24-hour Holter monitoring £250 to £500 and extended monitoring more. Full cardiac assessments with echocardiography and consultant review reach £1,500 to £3,000. Comprehensive imaging programmes at the top of the market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, remote appointments where nobody feels a pulse, records a rhythm or arranges monitoring, which for palpitations is the entire investigation.
At The Wellness the assessment, the coordination and the review are 1 fee. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Executive Body Scan, consultant-reported imaging including cardiac, carotid and aortic assessment with full bloods and consolidated review, from £5,995.
Heart Health programme, echocardiography with carotid Doppler and aortic assessment plus a cardiometabolic panel and review, from £3,495.
Athlete Screen, cardiac assessment with musculoskeletal imaging and bloods, from £1,695.
Comprehensive Blood Panel including thyroid, ferritin and iron studies, electrolytes, kidney function, glucose and lipids with apolipoprotein B, with consultation and interpretation, from £495.
Extended 45-minute consultation for complex or recurrent palpitations, from £395.
In-person consultation with cardiovascular examination in Marylebone, from £220. Same-day video consultation from £150.
ECG, 24-hour to 14-day rhythm monitoring, echocardiography and cardiology referral to a named consultant arranged at specialist centres with consultant reporting and the appointment booked.
Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.
Why The Wellness is the best place in London for palpitations
Because the monitoring is matched to the symptom rather than to whatever the clinic owns. A 24-hour tape is the default almost everywhere and it is the wrong test for anyone whose palpitations occur weekly or monthly. Matching the recording duration to the frequency is the single decision that determines whether you get an answer, and it costs nothing to get right.
Because the non-cardiac causes are tested at the same time rather than after the cardiac workup comes back normal. Thyroid function, ferritin and iron studies, electrolytes and magnesium in the same panel, so the overactive thyroid or the iron deficiency that has been causing this for 8 months is found in the first round rather than the third.
And because a confirmed arrhythmia is acted on properly. AF means a CHA2DS2-VASc assessment and a stroke prevention decision, not just rate control, because the strokes AF causes are more severe and more often fatal than others. Where cardiology input is needed the referral goes to a named consultant with the appointment booked, and the drivers, including sleep apnoea investigated with a home study, are addressed rather than ignored.
Book a cardiac assessment on WhatsApp or call 020 3951 3429.
Frequently asked questions
When should I worry about palpitations
Palpitations with chest pain, severe breathlessness or a feeling of impending collapse need emergency assessment now. Blackout or near-blackout during palpitations, palpitations on exertion rather than at rest, a family history of sudden cardiac death under 40, or a sustained irregularly irregular pulse all need prompt assessment.
What causes palpitations
Ectopic beats are commonest and usually harmless, worse with caffeine, alcohol, poor sleep, stress and dehydration. Atrial fibrillation is the important minority. Non-cardiac causes routinely missed include an overactive thyroid, iron deficiency anaemia, low potassium or magnesium, anxiety, and medications including salbutamol, decongestants and thyroid replacement at too high a dose.
Why was my ECG normal when I still get palpitations
Because a resting ECG records around 10 seconds, so unless symptoms occur during it, it usually looks normal. Intermittent symptoms need prolonged monitoring matched to their frequency, from a 24-hour or 48-hour Holter for daily symptoms to 7 or 14-day monitoring or an event recorder for weekly or monthly ones.
How serious is atrial fibrillation
It raises stroke risk around 5-fold when untreated and causes roughly 1 in 5 strokes, which tend to be more severe than others. Anticoagulation, decided using the CHA2DS2-VASc score, reduces that risk substantially. Aspirin is not adequate stroke prevention in atrial fibrillation.
Do I need an echocardiogram for palpitations
Not always. It is indicated where there is a murmur, breathlessness, an abnormal ECG, a family history of inherited cardiac disease or a confirmed arrhythmia, because it assesses the heart structure and function that the rhythm sits on. We arrange it at a specialist centre with consultant reporting where the assessment indicates it.
Can anxiety cause palpitations
Yes, and it is a real cause rather than a diagnosis of exclusion. It should be diagnosed positively on its own features while the treatable physical causes, particularly thyroid disease and iron deficiency, are tested in the same panel, because both produce anxiety-like symptoms and both are commonly missed.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Cardiac monitoring, echocardiography and imaging are arranged at specialist centres and reported by consultants, and blood analysis is performed by accredited laboratories. Palpitations with chest pain, severe breathlessness or blackout need emergency assessment, and in an emergency call 999. This article is general information and not a substitute for medical advice about your own health.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. NICE guideline NG196 on atrial fibrillation diagnosis and management, including CHA2DS2-VASc assessment and anticoagulation. NICE Clinical Knowledge Summaries on palpitations, atrial fibrillation and supraventricular tachycardia. British Heart Foundation and NHS data on atrial fibrillation prevalence in the UK and its contribution to stroke. Published evidence on stroke risk in untreated atrial fibrillation and on the severity of AF-related stroke. NICE guideline NG202 on obstructive sleep apnoea. Published 2026 London private cardiology, echocardiography and rhythm monitoring market pricing.
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