Quitting smoking usually reduces nicotine-related stimulation of the heart. However, some people notice pounding, racing or skipped-beat sensations during the first days or weeks of quitting. Withdrawal-related anxiety, changes in caffeine exposure, nicotine-replacement treatment and unrelated rhythm problems may all contribute.
Heart palpitations can occur around the time you stop smoking, but they are not considered one of the main defining symptoms of nicotine withdrawal. In fact, nicotine raises heart rate and blood pressure, so your heart rate generally begins to fall after smoking stops. During the quit period, anxiety or restlessness may make the heartbeat more noticeable, and your usual caffeine intake may affect you more strongly because caffeine remains in the body longer after quitting. Nicotine-replacement products can also occasionally cause an abnormal heartbeat. Persistent, very fast or irregular palpitations should therefore be evaluated rather than automatically blamed on smoking withdrawal.
What Is Nicotine Withdrawal?
Nicotine is the main addictive drug in cigarettes and many other tobacco and nicotine products.
With repeated exposure, the brain adapts to the presence of nicotine. When nicotine is removed, temporary withdrawal symptoms can develop while the nervous system adjusts.
Common symptoms include:
- strong cravings for nicotine;
- irritability or frustration;
- restlessness or feeling “jumpy”;
- anxiety;
- difficulty concentrating;
- sleep problems;
- increased appetite; and
- temporary low mood in some people.
Symptoms can begin within hours of stopping and are often strongest during the first several days. For most people, they become less intense over the following days and weeks.
Major smoking-cessation resources emphasize cravings, irritability, restlessness, anxiety, concentration problems, sleep disturbance and appetite changes. A person may still notice palpitations during this period, but another mechanism may be responsible.
Why Might Heart Palpitations Occur After You Stop Smoking?
Several possibilities can explain the timing.
Withdrawal-related anxiety
Anxiety, restlessness and irritability are common during nicotine withdrawal. Anxiety can increase heart-rate awareness and sometimes make the heart feel as though it is racing or pounding.
See our guide to anxiety and heart palpitations .
Your usual caffeine dose may feel stronger
After smoking stops, caffeine remains in the body longer. Someone who continues drinking the same amount of coffee, tea or energy drinks may therefore experience more jitteriness, insomnia or heartbeat awareness than before.
Nicotine replacement
Nicotine patches, gum, lozenges, inhalers and nasal sprays deliver nicotine without cigarette smoke. They are much safer than smoking and can improve quit success, but nicotine can still affect heart rate and occasionally produce cardiovascular side effects.
An unrelated arrhythmia
PACs, PVCs, atrial fibrillation, SVT or another arrhythmia may happen to begin around the same time a person stops smoking. Timing alone does not prove that nicotine withdrawal caused the rhythm problem.
Sleep disturbance
Trouble sleeping is common during nicotine withdrawal. Poor sleep can increase sympathetic activity and make heartbeat sensations easier to notice.
Changes in routine and stress
Quitting changes daily routines and removes a behavior that may previously have been used to cope with stress. Temporary stress may make otherwise minor heartbeat sensations more noticeable.
Important Correction: Quitting Usually Lowers Nicotine-Driven Heart Rate
Nicotine stimulates the cardiovascular system and can raise heart rate and blood pressure.
After smoking stops, heart rate begins to fall from this nicotine-induced increase within minutes.
Therefore, stopping smoking should not be presented as though removal of nicotine normally causes the heart itself to speed up. Palpitations during the quit period need to be interpreted in their clinical context.
Why Caffeine Matters After You Quit Smoking
This is an important and often overlooked reason someone may feel “different” after stopping cigarettes.
Cigarette smoking changes how quickly the body processes caffeine. After smoking stops, caffeine can remain in the body longer.
As a result, the same amount of:
- coffee;
- tea;
- cola;
- energy drinks; or
- other caffeinated products
may cause stronger effects than it did before quitting.
These can include:
- jitteriness;
- restlessness;
- difficulty sleeping;
- tremor;
- a faster heartbeat; or
- more noticeable palpitations.
If caffeine seems to make your symptoms worse, temporarily reducing intake may help while your body adjusts.
Read more about caffeine and heart palpitations .
Can Nicotine Replacement Therapy Cause Palpitations?
Nicotine replacement therapy (NRT) delivers nicotine without the thousands of combustion products contained in cigarette smoke.
Available forms include:
- nicotine patches;
- nicotine gum;
- nicotine lozenges;
- nicotine inhalers; and
- nicotine nasal spray.
NRT is considered much safer than continuing to smoke and can reduce cravings and withdrawal symptoms.
However, because it still contains nicotine, some users can experience symptoms such as dizziness, nausea or changes in heartbeat.
Follow the instructions for the specific product and discuss persistent, fast or irregular heartbeat symptoms with a doctor or pharmacist. Do not assume that every symptom is harmless simply because NRT is generally safer than cigarettes.
What Is the Best Way to Stop Smoking?
The best evidence does not support telling everyone that “cold turkey” is the best method.
Some people do successfully quit without medicines, but cessation medications and behavioral support can make withdrawal easier and improve the likelihood of remaining smoke-free.
Combining Support and Medication Works Well
Evidence-based smoking-cessation treatment can combine:
- brief advice from a healthcare professional;
- individual counseling;
- group counseling;
- telephone support;
- digital or app-based support; and
- appropriate smoking-cessation medicines.
Combining behavioral support with pharmacotherapy generally improves the chance of successfully quitting compared with attempting to manage nicotine dependence without evidence-based assistance.
Nicotine replacement therapy
Over-the-counter forms include nicotine patch, gum and lozenge. Prescription nicotine inhalers and nasal sprays are also available in some countries.
Combination NRT — typically a long-acting patch together with a short-acting form such as gum or lozenge — can be more effective than using one NRT form alone in appropriate adults.
Varenicline
Varenicline is a prescription medicine that reduces nicotine cravings and reduces the rewarding effects of smoking.
A healthcare professional can help determine whether it is appropriate based on medical history and other medicines.
Bupropion SR
Sustained-release bupropion is another prescription medication approved for smoking cessation in adults.
It is not appropriate for everyone, so contraindications and other medicines need to be reviewed before it is prescribed.
What about nortriptyline?
Nortriptyline has been studied and used off-label for smoking cessation in selected circumstances, but it is not one of the standard FDA-approved first-line smoking-cessation medicines.
Important Correction: “Cold Turkey” Is Not Automatically the Best Method
The previous version of this article described abrupt cessation without medication as the best way to quit.
Some people succeed this way, but modern smoking-cessation guidance supports offering behavioral treatment and evidence-based pharmacotherapy. The best quit plan is the one that is medically appropriate, acceptable to the patient and most likely to lead to sustained abstinence.
Practical Ways to Handle Nicotine Withdrawal
Withdrawal is temporary, and several strategies can make the first days and weeks easier.
- Choose a quit date and prepare for common triggers.
- Remove cigarettes, lighters and ashtrays from your usual environment.
- Tell supportive family members or friends that you are quitting.
- Use evidence-based cessation medication if appropriate.
- Reduce caffeine if you become unusually jittery after quitting.
- Use physical activity such as walking to manage restlessness and cravings.
- Use sugar-free gum or another substitute for the hand-to-mouth habit.
- Plan alternatives for situations strongly associated with smoking.
- Expect cravings to come and go rather than interpreting them as failure.
- Seek additional counseling or medical support if previous quit attempts have been unsuccessful.
The cardiovascular benefits of stopping begin rapidly and continue over years. If a new symptom such as palpitations concerns you, have the symptom evaluated while continuing to work toward remaining smoke-free.
When Should Palpitations After Quitting Smoking Be Evaluated?
Palpitations deserve medical assessment if they:
- keep returning;
- are becoming more frequent;
- last longer than brief isolated beats;
- feel persistently fast;
- feel markedly irregular;
- continue after the initial withdrawal period;
- began after starting or changing nicotine-replacement treatment;
- occur during exercise;
- are associated with dizziness or unusual weakness;
- occur in someone with known heart disease; or
- are accompanied by other concerning symptoms.
What might your doctor check?
Depending on the symptoms, evaluation may include:
- heart rate and blood pressure;
- a medication and nicotine-product review;
- caffeine intake;
- a 12-lead ECG;
- blood tests for anemia, thyroid disease or electrolyte abnormalities when appropriate; and
- longer ECG monitoring if the palpitations are intermittent.
If the palpitation is not happening during the short ECG recording, a Holter, patch or event monitor may be needed to establish what rhythm is occurring when you actually feel the symptom.
For frequent symptoms, see our guide to constant and frequent heart palpitations .
Dr. Albana’s Note
When someone tells me their heart started pounding after they quit smoking, I do not recommend returning to cigarettes to see whether the symptom stops. I ask when the palpitations started, how much caffeine they are drinking, whether nicotine replacement is being used, whether the heartbeat feels fast or irregular and whether dizziness, chest discomfort or shortness of breath is present. Nicotine withdrawal can produce anxiety and restlessness, but recurrent palpitations still deserve their own evaluation.
Urgent Warning Signs
Seek urgent or emergency medical care if palpitations after quitting smoking occur with:
- significant chest pain or pressure;
- fainting or loss of consciousness;
- collapse;
- severe shortness of breath;
- severe dizziness or near-fainting;
- a sustained very rapid or markedly irregular heartbeat;
- new severe weakness; or
- rapidly worsening symptoms.
Do not assume that serious cardiovascular symptoms are simply nicotine withdrawal.
See our chest pain and heart palpitations guide for additional education, but emergency warning signs require urgent medical attention first.
Most Asked Questions
Can quitting smoking cause heart palpitations?
Palpitations may occur during the quit period, but they are not one of the main defining nicotine-withdrawal symptoms. Anxiety, restlessness, increased caffeine exposure, nicotine-replacement treatment or an unrelated rhythm problem may explain the symptom.
Does your heart rate increase when you stop smoking?
Usually the opposite occurs. Nicotine raises heart rate and blood pressure, and heart rate begins to fall after smoking stops. A temporary sensation of racing or pounding during withdrawal may have another explanation.
How soon does nicotine withdrawal begin?
Withdrawal can begin within hours after nicotine use stops and is commonly strongest during the first few days. Symptoms generally become less intense over the following days and weeks.
Can anxiety from quitting make my heart race?
Yes. Anxiety and restlessness are recognized nicotine-withdrawal symptoms and can increase heart-rate awareness or produce a racing sensation. Persistent or irregular palpitations should still be evaluated rather than automatically attributed to anxiety.
Why does coffee affect me more after I stop smoking?
Caffeine remains in the body longer after cigarette smoking stops. Your previous coffee or energy-drink intake may therefore produce stronger effects such as restlessness, insomnia, tremor or palpitations.
Can a nicotine patch cause palpitations?
Nicotine replacement is much safer than smoking, but it still contains nicotine and can occasionally affect the heartbeat. Persistent or abnormal rhythm symptoms after starting a nicotine product should be discussed with a healthcare professional.
Is quitting cold turkey the best way?
Not necessarily. Some people successfully quit without medication, but counseling and evidence-based smoking-cessation medicines improve quitting success and can reduce withdrawal symptoms. The best strategy should be individualized.
What medicines can help someone stop smoking?
In the United States, FDA-approved cessation treatments include nicotine replacement therapy, varenicline and sustained-release bupropion. Behavioral counseling is also effective, and combining counseling with medication generally improves quit success.
Should I start smoking again if palpitations began after quitting?
No. Returning to cigarette smoking re-exposes the cardiovascular system to nicotine and harmful combustion products. If palpitations are concerning, have them medically assessed while continuing your smoking-cessation plan.
How long should palpitations after quitting last?
There is no universal duration because the cause may not be nicotine withdrawal. Brief symptoms may improve as anxiety, sleep and caffeine effects settle, but recurrent, persistent, very fast or irregular palpitations deserve medical evaluation.
Related Heart Palpitation Guides
Medical References
- Centers for Disease Control and Prevention. 7 Common Withdrawal Symptoms. Updated October 2024. CDC .
- Centers for Disease Control and Prevention. How to Quit Smoking. CDC .
- Centers for Disease Control and Prevention. Benefits of Quitting Smoking. Updated May 2024. CDC .
- Smokefree.gov. Managing Nicotine Withdrawal. National Cancer Institute. Smokefree.gov .
- World Health Organization. WHO Clinical Treatment Guideline for Tobacco Cessation in Adults. 2024. WHO .
- U.S. Preventive Services Task Force. Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions. USPSTF .
- American Heart Association. The Benefits of Quitting Smoking Now. Reviewed January 2024. American Heart Association .
- American Heart Association. What to Know About Smoking, Nicotine and Vaping. American Heart Association .
- MedlinePlus. Nicotine Transdermal Patch. U.S. National Library of Medicine. MedlinePlus .
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.