Chest discomfort and a racing, pounding, fluttering or irregular heartbeat can occur together for many reasons. Sometimes the explanation is relatively benign, but certain combinations require urgent medical assessment.
Yes, chest pain and heart palpitations can occur together, but one does not necessarily cause the other. Anxiety, premature beats, a rapid heart rhythm, stimulants and several non-cardiac conditions can sometimes produce both sensations. More serious causes include acute coronary syndrome, significant arrhythmias, myocarditis, cardiomyopathy and pulmonary embolism. Because chest pain can occasionally signal an emergency, new or significant chest pain accompanied by palpitations should not simply be diagnosed at home.
Chest Pain With Palpitations: When Is It an Emergency?
Seek urgent or emergency medical care if you have new or significant chest pain or pressure with palpitations, particularly if you also have:
- severe or worsening chest pressure, squeezing or tightness;
- shortness of breath;
- fainting or loss of consciousness;
- severe dizziness or feeling that you may pass out;
- cold sweating, nausea or marked weakness;
- pain or discomfort spreading to the arm, shoulder, jaw, back or upper abdomen;
- a sustained very rapid or markedly irregular heartbeat;
- sudden unexplained shortness of breath or pain that worsens with breathing;
- coughing up blood;
- collapse; or
- rapidly worsening symptoms.
If you think you may be having a heart attack, pulmonary embolism or another medical emergency, call your local emergency medical service. Do not continue reading online while delaying emergency assessment.
Are Chest Pain and Palpitations Related?
They can be, but the relationship varies considerably from one person to another.
A palpitation is the sensation of being unusually aware of your heartbeat. It may feel like racing, fluttering, pounding, skipping or an extra beat.
Chest pain is also a symptom rather than a diagnosis. People may describe pressure, squeezing, burning, aching, sharp pain, heaviness or another form of discomfort.
Sometimes one condition causes both symptoms. In other cases, two different processes may be happening at the same time. For example, a person may have harmless premature beats while also experiencing chest-wall discomfort or reflux-related burning.
Some patients have a normal heart rhythm when they feel palpitations. Conversely, some arrhythmias cause few noticeable symptoms. Recording the heart rhythm during an episode is often more informative than trying to identify the rhythm from the sensation alone.
Our guide to heart palpitation symptoms explains the different sensations people commonly describe.
Common Reasons Chest Pain and Palpitations May Occur Together
Anxiety or panic
Stress and panic can increase heart rate, make the heartbeat more noticeable, tighten chest muscles and produce chest discomfort, breathlessness, trembling or dizziness.
However, new chest pain should not automatically be attributed to anxiety before important medical causes have been considered.
Premature beats
Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) can produce a thump, pause, flutter or skipped-beat sensation. Some people also describe brief chest discomfort around an extra beat.
Sinus tachycardia
Exercise, fever, dehydration, anxiety, pain, anemia and other conditions can make the normal sinus rhythm faster. The pounding heartbeat may be felt as palpitations while the underlying condition may produce other symptoms.
Caffeine and other stimulants
Caffeine, nicotine, energy drinks, some decongestants and other stimulants may cause a faster or more noticeable heartbeat in susceptible people.
See our guide to caffeine and heart palpitations.
Musculoskeletal chest pain
Chest-wall muscle strain or inflammation around the ribs can produce pain that changes with movement or pressure. A person may simultaneously notice an unrelated fast heartbeat or premature beats.
Digestive symptoms
Reflux or esophageal disorders can sometimes produce burning or discomfort behind the breastbone. Palpitations may occur separately at the same time. Digestive symptoms should not automatically be assumed to explain new or concerning chest pain.
A broader list of possible palpitation triggers is available in our causes of heart palpitations guide.
Important Medical Causes Doctors May Need to Exclude
The combination of chest pain and palpitations does not prove that one of these conditions is present. The symptoms can, however, occur in several important cardiovascular or pulmonary disorders.
1. Acute coronary syndrome and heart attack
Acute coronary syndrome occurs when blood flow through a coronary artery becomes suddenly reduced or blocked. A heart attack, or myocardial infarction, occurs when prolonged ischemia injures heart muscle.
Chest pressure or discomfort is a common symptom. Shortness of breath, sweating, nausea, lightheadedness and pain involving the arms, shoulder, jaw, back or upper abdomen may also occur.
Palpitations can occur during acute coronary syndromes, particularly when autonomic activation or an arrhythmia accompanies the ischemic event. They should not be explained as the heart simply “beating harder to overcome” an oxygen shortage.
2. Significant tachyarrhythmia
Supraventricular tachycardia, atrial fibrillation and other rapid rhythms can cause prominent palpitations.
When the rate is sufficiently fast or sustained, some people develop chest discomfort, breathlessness, weakness or dizziness. This may be particularly important in people who already have coronary or structural heart disease.
3. Myocarditis
Myocarditis is inflammation of the heart muscle. Its causes are varied and may include infections, immune-related disease and other triggers.
Possible symptoms include chest pain, shortness of breath, exercise intolerance and abnormal heart rhythms. Evaluation may include an ECG, cardiac blood tests, echocardiography or cardiac MRI depending on the clinical situation.
4. Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is a condition in which heart muscle becomes abnormally thick. Some people have no symptoms, while others may develop chest pain, palpitations, shortness of breath, dizziness or fainting, especially during exertion.
HCM can be obstructive or nonobstructive, and the mechanisms behind symptoms are more complex than simply saying that the thick muscle prevents the coronary arteries from receiving blood.
5. Heart valve disease
Significant valve disease can sometimes produce both chest discomfort and palpitations.
Mitral valve prolapse, for example, occurs when the mitral valve leaflets bulge toward the left atrium during contraction. Most cases are not dangerous. Some people experience palpitations or chest discomfort, and significant mitral regurgitation may increase the likelihood of arrhythmias in selected patients.
Mitral valve prolapse should therefore not be described as routinely causing atrial fibrillation or reduced cardiac output.
6. Pulmonary embolism
A pulmonary embolism occurs when a blood clot, usually originating from a deep vein, travels to and obstructs blood flow in the lungs.
Symptoms may include sudden unexplained shortness of breath, chest pain that may worsen with deep breathing, a fast heartbeat, dizziness, fainting and occasionally coughing up blood.
Pulmonary embolism can be life-threatening and requires urgent medical evaluation.
Important Correction: The Two Symptoms Do Not Automatically Mean Heart Disease
Older medical content sometimes implies that chest pain plus palpitations almost certainly indicates a dangerous cardiovascular disorder.
That is not correct. Many people evaluated for chest pain do not ultimately have a cardiac cause. The correct approach is not to assume either “harmless” or “life-threatening” from the symptoms alone. Instead, clinicians evaluate the characteristics of the pain, associated symptoms, cardiovascular risk, examination findings, ECG and other testing when appropriate.
Can Heart Palpitations or an Arrhythmia Cause Chest Pain?
Sometimes.
An isolated palpitation does not usually mean that the heart muscle is being deprived of oxygen. However, a sustained rapid arrhythmia can increase the heart’s workload and shorten the time available for the heart chambers and coronary circulation to fill between beats.
Some people therefore develop chest pressure or discomfort during a significant tachyarrhythmia. The likelihood and importance of this symptom depend on the heart rate, duration of the rhythm, age and whether underlying cardiovascular disease is present.
The reverse is also possible: a cardiac or systemic problem causing chest pain can produce stress responses or trigger an arrhythmia, resulting in palpitations.
This is why symptoms alone usually cannot tell you which came first.
How Do Doctors Evaluate Chest Pain With Palpitations?
The evaluation depends heavily on whether the symptoms are happening now, how severe they are, your age, cardiovascular risk factors and the presence of emergency warning signs.
Medical history
Your clinician may ask:
- when the chest discomfort began;
- whether it feels like pressure, tightness, burning, aching or sharp pain;
- how long it lasts;
- whether exertion, breathing, movement or meals influence it;
- whether the palpitations start suddenly or gradually;
- whether the heartbeat seems regular or irregular;
- whether you have dizziness, fainting, sweating, nausea or breathlessness;
- whether pain travels to the arm, shoulder, jaw, back or upper abdomen;
- what medicines, caffeine, nicotine or stimulants you use;
- whether you have cardiovascular disease or risk factors; and
- whether there is a relevant family history of heart disease or sudden death.
12-lead ECG
An electrocardiogram is an important test when an arrhythmia, acute coronary syndrome or another cardiac condition is suspected.
It can identify the rhythm and reveal some abnormalities associated with ischemia, conduction problems and other heart conditions.
A brief ECG only records a short period. If palpitations come and go, a Holter monitor, patch monitor or event recorder may be needed to capture the heart rhythm while symptoms are occurring.
Cardiac blood tests
When acute coronary syndrome or myocardial injury is suspected, clinicians may measure cardiac troponin. Current chest-pain guidance favors high-sensitivity cardiac troponin for detecting or excluding myocardial injury.
Additional blood tests
Depending on the situation, tests may also look for anemia, thyroid dysfunction, significant electrolyte disturbances or other conditions that can contribute to palpitations.
Echocardiogram
Echocardiography may be used when structural heart disease, cardiomyopathy, significant valve disease or certain other cardiac conditions are suspected.
Exercise or other cardiac testing
If symptoms are associated with exertion, exercise testing or other forms of cardiac assessment may sometimes be considered after the clinician determines that such testing is appropriate and safe.
Our related guide to heart palpitations after exercise explains this situation in more detail.
Dr. Albana’s Note
When a patient tells me they have both chest discomfort and palpitations, I do not assume immediately that the heart is the cause, but I also do not dismiss the combination as anxiety. I first want to know what the chest sensation feels like, what the heart is doing at the same time, how long the episode lasts, whether exercise triggers it, and whether there is breathlessness, dizziness or fainting. Those details help determine whether the person needs urgent assessment or a more routine investigation such as ECG or ambulatory rhythm monitoring.
When Should You Contact a Doctor?
Even when symptoms are not severe enough to require emergency care, arrange medical assessment if:
- chest discomfort keeps returning;
- palpitations repeatedly occur with chest discomfort;
- episodes are becoming more frequent or prolonged;
- your heartbeat becomes persistently fast or irregular;
- symptoms consistently occur with exercise;
- you develop recurrent dizziness or unusual weakness;
- you have known heart or lung disease;
- symptoms began after starting or changing a medicine;
- you have significant cardiovascular risk factors; or
- there is an important family history of inherited heart disease or unexplained sudden death.
If palpitations are becoming frequent even without chest pain, see our guide to constant or frequent heart palpitations.
If dizziness occurs with them, read dizziness and heart palpitations.
Most Asked Questions
Does chest pain with palpitations always mean a heart attack?
No. Anxiety, premature beats, rapid heart rate, chest-wall pain and several other conditions can produce or coexist with both symptoms. However, a heart attack is one of the serious causes that may need to be excluded when chest pain is new, significant or accompanied by other warning symptoms.
Can anxiety cause both chest pain and heart palpitations?
Yes. Anxiety and panic can increase heart rate, intensify heartbeat awareness and cause chest tightness or discomfort. However, new or unexplained chest pain should not automatically be diagnosed as anxiety without considering the clinical situation and possible medical causes.
Can an arrhythmia cause chest pain?
Yes. Some sustained rapid arrhythmias can cause chest discomfort, particularly when the heart rate is very fast or underlying cardiovascular disease is present. Other arrhythmias may cause palpitations without chest pain.
Can premature beats cause chest discomfort?
PACs and PVCs commonly feel like a skipped beat, flutter, pause or forceful thump. Some people describe brief discomfort around the beat. Persistent, frequent or concerning symptoms should be assessed rather than assuming that every chest sensation comes from premature beats.
Can acid reflux cause chest pain and palpitations?
Acid reflux can cause burning or discomfort behind the breastbone, while palpitations may occur separately at the same time. GERD should not automatically be assumed to cause an arrhythmia, and new concerning chest pain should not simply be attributed to reflux.
Can pulmonary embolism cause palpitations and chest pain?
A pulmonary embolism can produce chest pain, sudden or unexplained shortness of breath and a rapid or irregular heartbeat. Dizziness, fainting or coughing up blood can also occur. Suspected pulmonary embolism requires urgent medical care.
Can a normal ECG rule out the cause of my palpitations?
Not always. An ECG records the heart for only a short period. If symptoms occur intermittently, a Holter, patch or event monitor may be needed to capture the rhythm during an actual episode.
What if chest pain and palpitations happen during exercise?
Symptoms repeatedly associated with exercise deserve medical evaluation. Stop exercising if significant chest pain, severe breathlessness, dizziness or fainting occurs, and seek urgent assessment when symptoms are severe.
Related Heart Palpitation Guides
Medical References
- Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021. American Heart Association .
- American College of Cardiology/American Heart Association. 2025 Guideline for the Management of Patients With Acute Coronary Syndromes. AHA/ACC Acute Coronary Syndromes Guidance .
- American Heart Association. Symptoms, Diagnosis and Monitoring of Arrhythmia. Last reviewed October 2024. American Heart Association .
- American Heart Association. Common Tests for Arrhythmia. American Heart Association .
- National Heart, Lung, and Blood Institute. Myocarditis. NHLBI .
- National Heart, Lung, and Blood Institute. Pulmonary Embolism. NHLBI .
- American Heart Association. Hypertrophic Cardiomyopathy. American Heart Association .
- American Heart Association. Mitral Valve Prolapse. American Heart Association .
About the Medical Team
Dr. Albana Greca, MBBS, MMedSc
Family Physician / General Practitioner
Dr. Albana Greca has more than 20 years of experience in primary care, general medicine, chronic disease management, prevention, patient education and digital health.
Dr. Benard Shehu, MBBS, MS
Cardiologist
Dr. Benard Shehu has more than 19 years of cardiovascular experience, including clinical experience relevant to arrhythmias and cardiovascular disease.