What are the causes of palpitations
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These studies suggest that palpitations can be caused by cardiac arrhythmias, anxiety, nonarrhythmic cardiac problems, noncardiac problems, and medications.
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Causes of Palpitations: An Overview
Palpitations, characterized by an awareness of the heartbeat, can be described as sensations of rapid, irregular, or forceful heartbeats. These sensations can be alarming and are often a reason for seeking medical attention. Understanding the causes of palpitations is crucial for appropriate diagnosis and management.
Cardiac Arrhythmias as a Primary Cause
Common Arrhythmias Leading to Palpitations
Cardiac arrhythmias are a primary cause of palpitations. These include sinus tachycardia, atrial fibrillation, premature ventricular contractions, and ventricular tachycardia. In a study involving women with symptomatic palpitations, the majority of episodes were due to benign arrhythmias such as normal sinus rhythm, sinus tachycardia, and premature atrial or ventricular beats. However, clinically significant arrhythmias like atrial fibrillation and supraventricular tachycardia were also identified in a small percentage of cases.
Diagnostic Challenges and Tools
Diagnosing the specific type of arrhythmia can be challenging due to the transient nature of palpitations. Ambulatory electrocardiographic (ECG) monitoring, including Holter monitoring and event recorders, is often used to capture these episodes . Event recorders have been found to be more effective and cost-efficient compared to Holter monitors for diagnosing intermittent palpitations.
Non-Arrhythmic Cardiac Causes
Structural and Functional Heart Issues
Non-arrhythmic cardiac problems such as mitral valve prolapse, pericarditis, and congestive heart failure can also cause palpitations. These conditions may present with additional symptoms like dizziness, near-syncope, or syncope, which can indicate a more serious underlying issue.
Non-Cardiac Causes
Psychological Factors
Anxiety and stress are significant non-cardiac causes of palpitations. Up to a third of palpitation cases are attributed to psychological factors. These can manifest as panic attacks or generalized anxiety, leading to increased awareness of the heartbeat.
Metabolic and Endocrine Disorders
Metabolic and endocrine disorders, such as hyperthyroidism and hypoglycemia, can also lead to palpitations. Hyperthyroidism, in particular, increases the heart rate and can cause sensations of a racing heart.
Medication and Substance Use
Stimulant drugs, including caffeine and certain over-the-counter and prescription medications, can induce palpitations. Substance use, such as alcohol and recreational drugs, should also be considered as potential causes.
Special Populations
Cancer Patients
Cancer patients are at a higher risk for both arrhythmogenic and non-arrhythmogenic causes of palpitations. The management of palpitations in these patients requires a nuanced approach due to their complex medical histories.
Teenagers
In teenagers, palpitations are often due to increased cardiac awareness or fast/irregular cardiac rhythms. Minimal testing is usually sufficient for diagnosis, but cases with abnormal ECG findings or concerning family histories should be referred to a pediatric cardiologist.
Conclusion
Palpitations can arise from a variety of cardiac and non-cardiac causes. Cardiac arrhythmias are a primary cause, but psychological factors, metabolic disorders, and medication use are also significant contributors. Accurate diagnosis often requires a combination of patient history, physical examination, and targeted diagnostic testing. Understanding the diverse causes of palpitations is essential for effective management and improving patient outcomes.
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