Palpitations

DefinitionTop

Palpitations refer to an unpleasant sensation of a beating heart, usually because of changes in the frequency, rhythm, or intensity of heartbeats.

Causes and PathogenesisTop

Causes:

1) Heart disease: Mainly arrhythmia or conduction disturbances, ischemic heart disease, valvular heart disease, pericarditis, cardiomyopathy, heart failure.

2) Stimulants and drugs: Alcohol (abuse or withdrawal), caffeine, nicotine, amphetamines, cocaine, anticholinergics, beta2-agonists, beta-blockers (discontinuation), digitalis, theophylline, nitrates, epinephrine.

3) Metabolic disorders: Thyrotoxicosis, hypoglycemia, hypokalemia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, pheochromocytoma, menopause.

4) Other: Anemia, fever, pregnancy, stress, exercise, hyperventilation, migraine, emotional distress (eg, anxiety).

Clinical classification of palpitations: With normal rhythm or with arrhythmia; paroxysmal (sudden onset and sudden resolution) or nonparoxysmal (gradual development and resolution).

DiagnosisTop

1. History and physical examination: Ask the patient about how they perceive palpitations (sudden onset, rate, rhythm, location), circumstances in which palpitations have occurred, and any accompanying symptoms (eg, fatigue, dizziness, chest discomfort or pain, dyspnea, collapse or syncope). During physical examination assess the heart rate and rhythm, relationship between the heart rate and peripheral pulses, variability of heart sounds (eg, variable loudness of the first heart sound is suggestive of ventricular tachycardia), and presence of abnormal heart sounds and murmurs (see Heart Auscultation).

2. Diagnostic procedures: Electrocardiography (ECG) at rest, 24-hour or longer Holter ECG recording (48 h/72 h/7 days; up to 2 weeks with implantable devices), echocardiography, and other studies depending on the suspected cause.