Your heart can race when you climb stairs, flutter while lying in bed, and seem to skip a beat for no obvious reason. These sensations — often called heart palpitations — can be unsettling. So how do you know what’s normal, and when should you call your doctor?

Here, nurse practitioner Anthony Austin Horn of Novant Health Heart & Vascular Institute - Wilmington answers commonly asked questions about heart rate, irregular heartbeat and other matters of the heart that feel alarming but are often normal.

How fast should my heart be beating?

Normal heart rate is between 60 and 100 beats per minute. (Editor’s note: A normal resting heart should beat in time with The Beatles’ “All You Need Is Love” or Tina Turner’s “What’s Love Got to Do with It.”) That varies depending on your activity level, and how athletic you are. If your heart rate is on the higher end when you’re running, that’s a normal physiologic response. A slower heart rate while you’re resting is fine, as long as it isn't extremely slow or accompanied by symptoms — lightheadedness, fatigue, fainting, palpitations that come on with exertion — or family history of sudden cardiac death.

Is it normal to feel my heart flutter, and is it a sign of atrial fibrillation (AFib)?

This is one of the most common questions we get from our patients. Palpitations or skipped beats are hiccups in the heart rhythm. They’re typically benign and come from extra, early heartbeats from the top chambers (premature atrial contractions, or PACs) or the bottom chambers (premature ventricular contractions, or PVCs). After that early beat, there’s a pause followed by a stronger beat as the heart fills with blood. Almost everyone of every age gets an occasional heart flutter. Most of the time we don’t feel them because we’re distracted at work or focused on other things.

Heart palpitations are not necessarily a sign of AFib, one of the most common heart rhythm disorders. If you live with another health condition, like hypertension, that would be a concern. And if you’re feeling flutters more than occasionally while experiencing symptoms like dizziness or lightheadedness, it’s worth making an appointment with a cardiologist to rule out something serious.

Do I need a pacemaker or defibrillator?

That all depends. A pacemaker paces your heart when it’s abnormally slow. A defibrillator implant protects against dangerous fast rhythms from the lower chambers of the heart. Whether you need one of these devices depends on how well your heart is pumping and whether you’ve experienced a dangerous heart rhythm. For someone having occasional flutters, you probably don’t need a device. Your cardiologist can help you determine if you need an implanted heart device based on your heart history, such as if you’ve had open-heart surgery or a heart attack in the past.

Is it normal to feel my heartbeat when lying in bed at night?

Yes. When you’re lying down, you’re more relaxed and less distracted, especially when lying on your left side. That’s when your heart sits closer to your chest wall, which is why your heartbeat might feel more pronounced. Typically, nothing with your heart has changed; what’s changed is that you’re paying attention to it.

Is it normal for my smartwatch to say I have an irregular heartbeat?

Yes and no. Don’t ignore it, but also don’t panic. Our smartwatches have become more sophisticated and smarter, and those alerts do catch AFib a fair amount of the time. But they can also register false positives. If you have risk factors like high blood pressure, coronary artery disease, heart failure, or a family history of heart disease or abnormal heart rhythms, it's worth getting checked out. It’s a good idea to save your watch’s ECG (electrocardiogram) feature and bring it in for your appointment.

Is it normal for my heart to race when I climb stairs?

Yes, this is a physically demanding activity, especially when they are stairs you’re not used to climbing. Your legs need more blood and your muscles need more oxygen, so your heart has to work harder to support the demand. Your heart rate should recover within a few minutes of stopping. If it doesn't come back down appropriately, or stays elevated or keeps climbing after you've stopped, that's worth paying attention to.

What’s something patients might dismiss as normal but should get looked at?