Are cardiac palpitations a cardiovascular disease?

From the Guidelines

Cardiac palpitations are not a cardiovascular disease but rather a symptom that can occur in both healthy individuals and those with underlying heart conditions. Palpitations are sensations of rapid, irregular, or forceful heartbeats that a person can feel in their chest, throat, or neck. They can be triggered by various factors including stress, anxiety, caffeine, alcohol, certain medications, exercise, hormonal changes, and electrolyte imbalances. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, patients with palpitations often describe symptoms with characteristic features suggestive of SVT that may guide physicians to appropriate testing and a definitive diagnosis.

Key Points to Consider

• Palpitations can be benign and require no treatment, but they can sometimes signal underlying cardiovascular diseases such as arrhythmias, heart valve problems, or cardiomyopathy.
• If palpitations are frequent, severe, or accompanied by symptoms like chest pain, dizziness, shortness of breath, or fainting, medical evaluation is recommended.
• The diagnosis of SVT is often made in the emergency department, but it is common to elicit symptoms suggestive of SVT before initial electrocardiogram/electrocardiographic (ECG) documentation, as stated in the 2015 ACC/AHA/HRS guideline 1.
• Treatment depends on the cause and may include lifestyle modifications (reducing caffeine and alcohol, stress management), addressing electrolyte imbalances, or specific medications for underlying heart conditions.
• The distinction between palpitations as a symptom versus a disease is important because treating the underlying cause rather than just the sensation of palpitations is crucial for proper management, as emphasized in the ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias 1.

Importance of Accurate Diagnosis

The 2015 ACC/AHA/HRS guideline 1 highlights the importance of differentiating symptoms of SVT from symptoms of panic and anxiety disorders or any condition of heightened awareness of sinus tachycardia. A confounding factor in diagnosing SVT is the need to differentiate symptoms of SVT from symptoms of panic and anxiety disorders or any condition of heightened awareness of sinus tachycardia. Accurate diagnosis and treatment of the underlying cause of palpitations are essential to improve morbidity, mortality, and quality of life.

From the Research

Definition and Classification

• Cardiac palpitations are a common problem seen in family medicine, with most being of cardiac origin, although an underlying psychiatric disorder, such as anxiety, is also common 2.
• Palpitations can be associated with arrhythmias, extrasystoles, or awareness of sinus rhythm, and concurrent psychological problems are common and persistent 3.

Diagnosis and Evaluation

• Distinguishing cardiac from noncardiac causes of palpitations is important due to the potential risk of sudden death in those with an underlying cardiac etiology 2, 4.
• A thorough history and physical examination, followed by targeted diagnostic testing, can distinguish cardiac conditions from other causes of palpitations 4.
• Standard 12-lead electrocardiography is an essential initial diagnostic test, and cardiac imaging is recommended if history, physical examination, or electrocardiography suggests structural heart disease 2.
• Event recorders are preferable to Holter monitors for patients with palpitations, as they yield more diagnoses and are more cost-effective 5.

Relationship to Cardiovascular Disease

• Cardiac palpitations can be a symptom of underlying cardiovascular disease, and patients with a history of cardiovascular disease, palpitations at work, or palpitations that affect sleep have an increased risk of a cardiac cause 4.
• Certain arrhythmias, such as atrial fibrillation, ventricular tachycardia, and long QT syndrome, can increase the risk of stroke or sudden death, and patients with these conditions should be referred to a cardiologist 2.
• However, most patients presenting to secondary care with palpitation do not have serious underlying cardiovascular conditions, and concurrent psychological problems are common and persistent 3.