Palpitation is the awareness of the beating heart. The symptoms are different from poundings experienced after exertion and are most commonly due to heightened awareness from anxiety and tension rather than heart disease.

Other non-cardiac triggers of palpitation include smoking, alcohol, caffeine, and prescription drugs.

Another symptom is the feeling of ‘heavy’ beats, which occur after a premature beat due to the longer time the heart fills with blood. If this arrhythmia is a regular occurrence, there may be a need for further investigation.

Rapid or irregular heartbeats may occur in people without heart disease but may also indicate cardiac arrhythmia. The individual will often feel weak because of reduced cardiac output, a situation suggesting that a 24-hour ambulatory monitor examination will aid diagnosis.

Where the arrhythmia causes atrioventricular dissociation (the atria and ventricles are not beating in synchronisation and thus contract at different rates), a ‘pounding’ in the neck may be felt as the atria contract against closed tricuspid and mitral valves. This phenomenon may be accompanied by a visual bulging in the neck, sometimes referred to as cannon waves or frog sign.