What causes palpitations
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Causes of Palpitations: An Overview
Palpitations, characterized by an unpleasant awareness of the heartbeat, can be caused by a variety of factors, both cardiac and non-cardiac. Understanding the underlying causes is crucial for effective 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 123. In women, symptomatic palpitations are often benign, caused by premature atrial or ventricular beats or stress-induced sinus tachycardia. However, clinically significant arrhythmias such as atrial fibrillation and supraventricular tachycardia are also observed .
Serious Arrhythmias and Associated Symptoms
Palpitations associated with dizziness, near-syncope, or syncope may indicate more serious arrhythmias and warrant thorough investigation . In teenagers, non-sinus tachycardia and abnormal ECG findings should prompt referral to a pediatric cardiologist .
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 18. These conditions affect the heart's structure and function, leading to irregular heartbeats.
Cardio-Oncology Considerations
In cancer patients, palpitations are common and can result from both arrhythmogenic and non-arrhythmogenic causes. The management of palpitations in these patients follows similar protocols to the general population but requires consideration of the unique cardiovascular risks associated with cancer and its treatments .
Non-Cardiac Causes
Psychological Factors
Anxiety is a significant non-cardiac cause of palpitations, with up to a third of cases attributed to psychological factors 45. Anxiety-induced sinus tachycardia is common, but anxiety can also coexist with cardiac arrhythmias, complicating the diagnosis .
Metabolic and Endocrine Disorders
Conditions such as hyperthyroidism, hypoglycemia, and vasovagal syncope can lead to palpitations by affecting the body's metabolic and endocrine balance 18. These disorders influence heart rate and rhythm through various physiological mechanisms.
Medication and Substance Use
Stimulant drugs, over-the-counter medications, and prescription drugs can induce palpitations. It is essential to review a patient's medication history to identify potential pharmacological causes 19.
Diagnostic Approaches
Initial Assessment and Monitoring
A thorough history and physical examination are critical in distinguishing cardiac from non-cardiac causes of palpitations. Ambulatory electrocardiographic (ECG) monitoring, including Holter monitoring and event recording, is often used to capture transient arrhythmias 19.
Advanced Diagnostic Tools
For persistent or unexplained palpitations, advanced diagnostic tools such as trans-telephonic event monitors and invasive electrophysiological studies may be necessary. These tools help in identifying specific arrhythmias and guiding appropriate treatment 18.
Conclusion
Palpitations can arise from a wide range of cardiac and non-cardiac causes. Cardiac arrhythmias are a primary concern, but psychological factors, metabolic disorders, and medication use also play significant roles. Accurate diagnosis through detailed history, physical examination, and targeted diagnostic testing is essential for effective management and treatment.
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Most relevant research papers on this topic
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.
The teenager with palpitations.
Teenagers with palpitations can often be diagnosed with minimal testing, but those with abnormal ECG, non-sinus tachycardia, abnormal cardiac examination, or concerning family history should be referred to a pediatric cardiologist for further evaluation.
Palpitations: what is the mechanism, and when should we treat them?
Palpitations are often caused by primary cardiac arrhythmias, and their treatment depends on the type of arrhythmia detected during electrophysiological studies.
Palpitations: Evaluation in the Primary Care Setting.
A thorough history and physical examination can help distinguish cardiac from noncardiac causes of palpitations, reducing the risk of sudden death.
Management of patients with palpitations: a position paper from the European Heart Rhythm Association.
The European Heart Rhythm Association position paper aims to improve diagnostic and therapeutic management of palpitations, aiming to reduce recurrence and improve patient quality of life.
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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.
DOI