Palpitations (Dil Ki Dharkan Tez): Chai, Anxiety or Rhythm?
Your heart suddenly thumping, racing or skipping (dil ki dharkan tez) is most often caffeine, anxiety, a hot dehydrated day or simply lying on your left side, and it settles on its own. What turns heart palpitations into a “when to worry” moment is what comes with them. This guide shows the one home check a doctor will ask about, the usual causes in the order they’re found, and the exact signs that need a doctor today.
The short version
- Do this first: count your pulse for 30 seconds, double it, and note whether the beat is regular, regularly skipping, or all over the place.
- Most common causes: doodh patti and coffee, energy drinks, anxiety, dehydration, poor sleep, nicotine and naswar.
- Emergency: palpitations with chest pain, fainting or breathlessness; a completely irregular racing pulse.
- Same day: a resting pulse over 120 that doesn’t settle after 20 minutes of sitting, or any palpitations with known heart disease.
Prefer to listen? This post as a 2 min video · Watch the video
What palpitations feel like, and why they’re usually harmless
A palpitation is simply noticing your own heartbeat. Normally you don’t. When you do, it may feel like pounding in the chest or neck, a flutter, a sudden flip, or a beat that seems to pause and then thump.
That “skip then thump” is usually an extra beat (an ectopic beat). The heart fires one beat a little early, there’s a short pause, and the next beat lands harder because the chamber had extra time to fill. Most healthy adults have these every day without feeling them. Tiredness, caffeine and stress make you notice them more.
A doctor can’t examine a palpitation that stopped yesterday, but they can read the numbers you wrote down.
The home check: count your own pulse
This is the single most useful thing you can bring to a clinic, and it takes a minute.
- Sit down and rest for 5 minutes.
- Turn your left palm up. Place the index and middle fingers of your right hand on the thumb side of the wrist, just below the crease. Press lightly until you feel the beat. (Don’t use your thumb; it has its own pulse.)
- Watch a clock or phone timer. Count beats for 30 seconds and double it. That’s your pulse per minute.
- While counting, notice the rhythm: steady like a clock, steady with an occasional skip, or completely irregular with no pattern at all.
- Write down the number, the rhythm, the time and what you’d done in the previous three hours: cups of chai or coffee, an energy drink, a cigarette or naswar, a meal skipped, a stressful call, exercise.
A normal resting adult pulse is roughly 60 to 100. Fit people can sit in the 50s. A phone app or smartwatch can help, but a watch’s number during a flutter isn’t always accurate, so check it against your fingers.
Heart palpitations causes, from most to least common
Caffeine
The house limit is 400 mg of caffeine a day for adults and 200 mg in pregnancy. Roughly: a cup of strong doodh patti holds 40 to 60 mg, a mug of brewed or instant coffee 80 to 100 mg, a 250 ml energy drink around 80 mg, and a can of cola 30 to 40 mg. So six strong cups of chai and two coffees can put an office worker past the line without anyone noticing.
Watch the hidden ones too. “Stamina” pre-workout powders and some slimming or “gainer” products carry stimulants that aren’t always on the label; see herbal slimming powders for how to spot them.
Anxiety and panic
Adrenaline speeds the heart. Palpitations with a tight chest, shaky hands, tingling fingers and a sense of dread, often at night or before a big event, are commonly anxiety. The steps for this pattern are in bechaini and restlessness at night.
Heart palpitations at night when lying down
Lying on the left side presses the heart closer to the chest wall, and in a quiet room you hear and feel a perfectly normal beat. Turning onto your right side or back usually makes it fade. That’s not a disease.
Other common triggers
- Low sugar in anyone on diabetes medicine: sweating, shaking and a racing heart. Check sugar if you have a meter.
- Dehydration and heat, especially after a long day outdoors or during a fast.
- Fever: the pulse rises with temperature.
- Anaemia and an overactive thyroid, both simple blood tests.
- Nicotine from cigarettes, vapes, sheesha, naswar and gutka.
- Some medicines, including certain inhalers and cold remedies. Ask the pharmacist whether any of yours can do this; don’t stop them yourself.
- Pregnancy, when the heart works harder than usual.
Less often, the cause is a rhythm problem such as atrial fibrillation (an irregular, often fast beat) or a sudden run of very fast regular beats. These are why the red flags below matter. Rhythm trouble is also one of the causes of dizziness covered in chakkar aana and dil ghabrana.
Are palpitations a sign of heart problems? The red flags
Call 1122 (Pakistan) or 112 (India) now if palpitations come with:
- chest pain, pressure or tightness
- fainting, or nearly fainting
- breathlessness at rest
- a pulse that’s racing and completely irregular, especially with dizziness
See a doctor the same day if:
- the resting pulse is over 120 and hasn’t settled after 20 minutes of sitting quietly
- palpitations happen during exercise rather than after it
- the person already has heart disease, a heart valve problem or a pacemaker
- someone in the family died suddenly and unexpectedly before 50
- a person with diabetes has palpitations with sweating that don’t improve after the low-sugar steps
Book a routine appointment for repeated harmless-feeling skips that bother you, or palpitations that keep coming for more than a couple of weeks.
What to do today
The two-week caffeine test
For 14 days, cut to two cups of chai a day, no coffee after lunch and no energy drinks or cola. Drop slowly over three days if you drink a lot, or the headache will make you give up. Keep your pulse diary going. If the palpitations fade, you have your answer.
- Drink water through the day, more in the heat; pale yellow urine is the aim.
- Slow breathing: in through the nose for a count of 4, out through the mouth for a count of 6, for 5 minutes. A longer out-breath calms the heart.
- Sleep: short nights make extra beats more noticeable.
- If you use nicotine, palpitations are one more reason to stop; a doctor or pharmacist can help.
You take BP, thyroid, heart, diabetes or mental-health medicine: don’t start, stop or change any of it because of palpitations; tell the doctor who prescribed it. Pregnant women with palpitations and breathlessness or swollen legs should be seen the same day. Children with palpitations, or who faint during sport, need a doctor, not a caffeine cut. Avoid “heart tonics” and herbal calmers bought on the promise of steadying the heart; some contain stimulants or interact with medicines.
What the doctor may do, and what to ask
Bring the diary. Expect an ECG, a quick tracing of the heart’s electrical activity. If the palpitations come and go, it may look normal on the day, so the doctor may suggest a 24-hour or longer heart monitor (a Holter), plus blood tests for haemoglobin, thyroid and salts such as potassium.
Questions worth asking: “Was the ECG normal, and does a normal one rule out a rhythm problem?” “Should I wear a monitor?” “Do my thyroid and haemoglobin need checking?” “Is my caffeine intake a likely cause?”
More guides on everyday symptoms and home care sit in the Desi Remedies section.
Myth: palpitations always mean a weak heart
Most palpitations come from a healthy heart reacting to caffeine, adrenaline or heat. “Dil kamzor hai” is a common family verdict, and it sends people to costly tonics instead of a simple ECG. The opposite myth is just as risky: that a young, fit person can ignore palpitations that come with fainting. Those need a check, whatever the age.
Palpitations questions people ask
When should you worry about heart palpitations?
Worry, and call an ambulance, if they come with chest pain, fainting, breathlessness, or a racing irregular pulse. See a doctor the same day for a resting pulse over 120 that won’t settle in 20 minutes, palpitations during exercise, or known heart disease. Short skips on their own, with none of these, are usually harmless.
Why do heart palpitations happen at night when lying down?
Lying on the left side brings the heart closer to the chest wall, and a quiet room makes a normal beat easier to notice. Late chai, a heavy dinner and anxiety add to it. Try the right side; if they come with breathlessness or you need to sit up, see a doctor.
Are palpitations a sign of heart problems?
Usually not. Most are extra beats or a fast normal rhythm from caffeine, stress or heat. They can signal a rhythm problem, which is why an ECG is sensible if they are frequent, irregular or come with other symptoms.
Are heart flutters dangerous?
A brief flutter that passes in seconds is very rarely dangerous. A flutter that keeps going for minutes, feels completely irregular, or comes with dizziness or breathlessness needs a medical check.
Can chai or coffee cause palpitations?
Yes, caffeine is the most common trigger. The house limit is 400 mg a day for adults and 200 mg in pregnancy, and several strong cups of chai plus coffee can pass it. A two-week cutback is a useful test.
Can dehydration cause palpitations?
Yes. With less fluid in the blood, the heart beats faster to keep up, especially in the heat or during a fast. Drinking water and resting in the shade usually settles it; if it doesn’t within an hour, get checked.
What is a normal pulse rate?
For a resting adult, roughly 60 to 100 beats a minute. Fit adults can be lower. A resting pulse over 120 that doesn’t come down after 20 minutes needs a doctor the same day.
Can anxiety cause palpitations every day?
It can, especially with poor sleep and high caffeine. It’s still worth one ECG and blood tests to be sure, and then working on the anxiety itself rather than worrying about each beat.
Do palpitations damage the heart?
Ordinary extra beats don’t. Some rhythm problems, if left untreated for a long time, can strain the heart or raise stroke risk, which is why persistent or irregular palpitations should be assessed.
Can low blood sugar cause a racing heart?
Yes. In people on diabetes medicine, a racing heart with sweating, shaking or hunger can be low sugar. Check your sugar if you can, follow the low-sugar steps your doctor gave you, and get help if it doesn’t improve.
Which test is done for palpitations?
An ECG first. If it’s normal and the symptoms come and go, a 24-hour or longer Holter monitor is common, along with blood tests for haemoglobin and thyroid.
Are palpitations normal in pregnancy?
A slightly faster heart is common in pregnancy. Palpitations with breathlessness, chest pain, fainting or swollen legs need a doctor the same day.