Palpitations causes
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Common Causes of Palpitations: Cardiac Arrhythmias and Psychological Factors
Palpitations, or the sensation of an abnormal or forceful heartbeat, are most often caused by cardiac arrhythmias or anxiety and stress-related conditions. Arrhythmias that can lead to palpitations include sinus tachycardia, atrial fibrillation, premature atrial or ventricular contractions, and supraventricular or ventricular tachycardia. However, most palpitations are benign and are frequently due to premature beats or stress-induced sinus tachycardia, especially in women. Anxiety and psychological factors are also significant contributors, with up to a third of cases linked to psychological causes such as panic, stress, or anxiety disorders. In many cases, palpitations are not associated with any underlying heart rhythm abnormality, and a substantial proportion of patients may have no identifiable cause after evaluation 1234+3 MORE.
Structural and Non-Arrhythmic Cardiac Causes of Palpitations
While arrhythmias are the most common cardiac cause, structural heart diseases can also result in palpitations. Mitral valve prolapse is a leading structural cause, but other conditions such as mechanical prosthetic valves, severe mitral or aortic regurgitation, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and rare cardiac tumors like myxomas should be considered. These structural abnormalities can predispose patients to arrhythmias and, in rare cases, sudden cardiac death. Nonarrhythmic cardiac issues, such as pericarditis and congestive heart failure, may also present with palpitations 1568.
Non-Cardiac and Systemic Causes of Palpitations
Palpitations can also arise from non-cardiac causes. Common systemic contributors include hyperthyroidism, hypoglycemia, anemia, and vasovagal syncope. Stimulant drugs, over-the-counter medications, and certain prescription drugs are known to provoke palpitations. Rarely, gastrointestinal conditions like Chilaiditi syndrome have been reported as unusual causes 157.
Neurocardiology and the Perception of Palpitations
The perception of palpitations is influenced by the brain’s processing of cardiac signals, a phenomenon known as cardioception. Individuals with higher interoceptive awareness, such as those with anxiety disorders, may be more likely to notice palpitations. Conversely, those with psychiatric conditions like depression or schizophrenia may have reduced awareness. This highlights the role of the central nervous system in modulating the experience of palpitations, independent of actual cardiac events .
Diagnostic Approach to Palpitations
A thorough history, physical examination, and 12-lead ECG are the first steps in evaluating palpitations. If structural heart disease is suspected, echocardiography is recommended. For frequent or unexplained palpitations, ambulatory ECG monitoring (such as Holter or event monitors) is useful. In most cases, palpitations are benign, but if associated with symptoms like dizziness or syncope, further investigation is warranted to rule out serious arrhythmias or structural heart disease 1356+1 MORE.
Conclusion
Palpitations are a common symptom with a wide range of causes, most often benign and related to arrhythmias or psychological factors. Structural heart disease, systemic conditions, and medications are less common but important causes. The perception of palpitations is influenced by both cardiac and neurological factors. A systematic diagnostic approach helps identify the underlying cause and guides appropriate management.
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Rare Right Ventricular Obstructing Myxoma: An Incidental Finding for a Common Symptom
Patients with palpitations should have a transthoracic echocardiogram to rule out structural causes, as myxomas carry a high risk of sudden death through thromboembolic events or dysrhythmias.
P6574Symptomatic palpitations causing anxiety in women, what are the underlying arrhythmias
Most symptomatic palpitations in women are benign, but in 5% previously undiagnosed atrial fibrillation or supraventricular tachycardia are found.
Instant electrocardiogram feedback with a new digital technique reduces symptoms caused by palpitations and increases health-related quality of life (the RedHeart study).
Instant ECG feedback during palpitations reduces symptoms, anxiety, and depression, and improves health-related quality of life in women.
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