What causes heart palpitations
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Causes of Heart Palpitations
Heart palpitations, characterized by an abnormal awareness of the heartbeat, can be a distressing symptom for many individuals. These sensations can range from feeling like the heart is racing, pounding, fluttering, or skipping beats. Understanding the underlying causes of palpitations is crucial for appropriate diagnosis and management.
Cardiac Arrhythmias
Common Arrhythmias Leading to Palpitations
Cardiac arrhythmias are one of the primary causes of heart palpitations. These include conditions such as sinus tachycardia, atrial fibrillation, premature ventricular contractions, and ventricular tachycardia . Sinus tachycardia, where the heart rate increases in response to signals from the body, can be a normal physiological response to factors like exercise, fever, or excitement. However, arrhythmias can also indicate more serious underlying heart conditions, especially if accompanied by symptoms like dizziness or syncope .
Gender Differences in Arrhythmias
Research indicates that women are particularly prone to palpitations caused by benign arrhythmias such as premature atrial or ventricular beats and stress-induced sinus tachycardia. However, clinically significant arrhythmias like atrial fibrillation and supraventricular tachycardia are also found in a small percentage of women experiencing palpitations.
Non-Arrhythmic Cardiac Causes
Structural Heart Diseases
Non-arrhythmic cardiac issues such as mitral valve prolapse, pericarditis, and congestive heart failure can also lead to palpitations . Mitral valve prolapse, in particular, is a significant cause of palpitations in females, while myocardial diseases are more frequently diagnosed in males.
Other Cardiac Conditions
Other conditions like cardiomyopathy and congenital heart diseases (CHD) are also notable causes of palpitations. These conditions often require detailed diagnostic evaluations, including echocardiography, to identify the underlying cardiac problems.
Non-Cardiac Causes
Psychological Factors
Anxiety and stress are common non-cardiac causes of palpitations. Up to a third of patients with palpitations may have psychological causes, such as panic or anxiety disorders . These psychological factors can significantly impact the quality of life and may require a different therapeutic approach compared to cardiac causes.
Systemic Non-Cardiac Diseases
Systemic conditions like hyperthyroidism, hypoglycemia, and vasovagal syncope can also cause palpitations. These conditions affect the heart rhythm indirectly and need to be considered during diagnosis .
Substance Use and Medications
Stimulant drugs, including caffeine, nicotine, and certain over-the-counter and prescription medications, can provoke palpitations. It is essential to review a patient's medication history and substance use when evaluating palpitations .
Diagnostic Approaches
Ambulatory ECG Monitoring
When the cause of palpitations is not immediately apparent from the patient's history, physical examination, and resting ECG, ambulatory ECG monitoring is often indicated. Continuous closed-loop event recording and Holter monitoring are useful tools for capturing intermittent palpitations and identifying underlying arrhythmias.
Echocardiography
Echocardiography is particularly useful in detecting structural heart diseases that may cause palpitations. It helps in identifying conditions like mitral valve prolapse, myocardial diseases, and congenital heart diseases.
Conclusion
Heart palpitations can arise from a variety of cardiac and non-cardiac causes. Cardiac arrhythmias, structural heart diseases, psychological factors, systemic conditions, and substance use are all potential contributors. Accurate diagnosis through thorough history-taking, physical examination, and targeted diagnostic tests is essential for effective management and treatment of palpitations. Understanding the diverse etiologies can help in tailoring appropriate therapeutic strategies and improving patient outcomes.
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