Heart palpitations don't produce audible sounds like a machine or a bell-they're internal sensations of irregular or forceful heartbeats. People often describe them as a pounding, fluttering, skipping, or racing feeling in the chest, neck, or throat. These sensations may last seconds or minutes and are usually felt rather than heard.
Palpitations are not a sound in the traditional sense. They are neurological interpretations of cardiac activity. The brain receives signals from the heart's electrical system and interprets changes in rhythm or force as distinct physical experiences. What someone hears-or thinks they hear-is actually a perception of motion, pressure, or vibration in the chest wall.
For example, during a premature ventricular contraction (PVC), a person may feel a sudden "thump" or "lurch" in the chest, followed by a pause and then a stronger beat. This sequence is often described as "my heart stopped, then kicked in." There is no actual sound produced-just a sensory impression shaped by the body's response to altered blood flow and nerve signaling.
People report palpitations using vivid, subjective language. Common comparisons include:
These descriptions are not metaphors-they reflect real neural feedback. A 2021 study published in Heart Rhythm found that 68% of patients reporting palpitations used emotional or metaphorical language to describe the sensation, underscoring how deeply personal the experience is.
Some individuals report hearing a "whooshing" or "pulsing" noise in their ears during episodes. This is not the heart making sound-it's the result of increased blood flow through the carotid arteries, which can create a rhythmic auditory sensation known as pulsatile tinnitus. This is a secondary effect, not a direct sound from the heart itself.
The sensation arises from changes in heart rate, rhythm, or contractile force. Common triggers include:
For instance, a patient with paroxysmal SVT may report a sudden onset of a "thunderclap" sensation in the chest, lasting 30 seconds to several minutes. The episode ends abruptly, often with a return to normal rhythm. This is due to a brief surge in heart rate, typically exceeding 150 beats per minute, which the body registers as intense movement.
According to the American Heart Association, palpitations are often benign, especially in otherwise healthy adults. However, they can signal underlying conditions like hyperthyroidism, anemia, or structural heart disease. Persistent or worsening episodes require medical evaluation.
Palpitations are frequently mistaken for panic attacks, but the two differ in timing and context. Panic attacks often begin suddenly, peak within 10 minutes, and include sweating, trembling, and fear of dying. Palpitations may occur during rest, exercise, or stress-but they are not always tied to anxiety.
Another common confusion is between palpitations and heart murmurs. Murmurs are audible sounds caused by turbulent blood flow, detectable with a stethoscope. They are not felt internally and are often described as a "whooshing" or "swishing" noise. Palpitations are not audible at all-they are felt.
Some people confuse palpitations with muscle twitches or spasms in the chest wall. These are unrelated to heart function and typically involve localized, brief contractions of intercostal muscles. Unlike palpitations, they don't correlate with heart rhythm and are not associated with dizziness or fainting.
Not all palpitations require treatment. But certain signs indicate a need for prompt assessment:
For example, a 45-year-old woman reported experiencing palpitations while lying still at night. She described a "racing heartbeat that felt like a drumbeat in my throat." After a 24-hour Holter monitor confirmed paroxysmal atrial tachycardia, she was treated with beta-blockers and experienced complete resolution. Her symptoms were not anxiety-related, despite initial concern.
Heart palpitations do not make a sound. They are internal sensations of irregular or forceful heartbeats. Descriptions like "fluttering," "pounding," or "skipping" reflect how the nervous system interprets cardiac activity. While most are harmless, persistent or symptomatic episodes warrant clinical evaluation to rule out arrhythmias or structural issues.