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 . 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 . 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 . 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 . 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 .
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 .
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 .
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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