Heart palpitations causes
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Causes of Heart Palpitations
Heart palpitations, characterized by sensations of a rapid, irregular, or unusually strong heartbeat, can be alarming for many individuals. Understanding the underlying causes is crucial for appropriate diagnosis and management. This article synthesizes the research on the various causes of heart palpitations.
Cardiac Arrhythmias
Common Arrhythmias
Cardiac arrhythmias are a primary cause of heart palpitations. These include sinus tachycardia, atrial fibrillation, premature ventricular contractions, and ventricular tachycardia . Arrhythmias can lead to palpitations that are sometimes associated with more severe symptoms such as dizziness, near-syncope, or syncope, indicating a potentially serious condition .
Diagnostic Importance
Distinguishing between cardiac and non-cardiac causes is essential due to the risk of sudden death associated with underlying cardiac conditions. A thorough history, physical examination, and targeted diagnostic testing, including electrocardiography (ECG) and cardiac imaging, are recommended to identify the specific type of arrhythmia .
Non-Arrhythmic Cardiac Causes
Structural Heart Disease
Non-arrhythmic cardiac issues such as mitral valve prolapse, pericarditis, and congestive heart failure can also cause palpitations . These conditions often require imaging studies to assess the structural and functional aspects of the heart .
Cardio-Oncology Considerations
In cancer patients, palpitations are a frequent complaint and can be due to both arrhythmogenic and non-arrhythmogenic causes. The management of palpitations in these patients follows similar protocols to the general population but with additional considerations for their oncological status.
Non-Cardiac Causes
Psychological Factors
Anxiety and stress are significant non-cardiac causes of palpitations. Up to a third of patients with palpitations may have psychological causes such as panic or anxiety disorders . It is important to rule out true arrhythmic causes before attributing palpitations to psychological factors.
Systemic Conditions
Systemic non-cardiac conditions such as hyperthyroidism, hypoglycemia, and vasovagal syncope can also lead to palpitations . These conditions often require specific diagnostic tests to identify the underlying systemic issue.
Substance Use and Medications
Stimulant drugs, including caffeine, nicotine, and certain over-the-counter and prescription medications, can provoke palpitations. A detailed history of substance use and medication intake is crucial for identifying these causes .
Diagnostic Approaches
Monitoring Techniques
For patients with unpredictable or infrequent palpitations, ambulatory ECG monitoring, such as Holter monitoring or trans-telephonic event monitors, is often indicated. These tools help capture the heart's activity over extended periods, providing valuable data for diagnosis .
Special Populations
In women experiencing symptomatic palpitations, a significant proportion may have benign arrhythmias. However, clinically important arrhythmias such as atrial fibrillation and supraventricular tachycardia can also be present, necessitating thorough evaluation.
Conclusion
Heart palpitations can arise from a variety of cardiac and non-cardiac causes. Accurate diagnosis through comprehensive history-taking, physical examination, and targeted diagnostic testing is essential for effective management. Understanding the diverse etiologies of palpitations helps in tailoring appropriate therapeutic strategies and improving patient outcomes.
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