From the Guidelines
No, a palpitating heart is not always indicative of tachycardia. Heart palpitations are sensations of the heart beating irregularly, fluttering, pounding, or racing, but they don't necessarily mean the heart rate is elevated above 100 beats per minute (the definition of tachycardia) 1. Palpitations can occur with normal heart rates and can be caused by various factors including anxiety, stress, caffeine, alcohol, nicotine, certain medications, hormonal changes, or electrolyte imbalances. Even premature beats, where the heart contracts slightly earlier than normal but at an otherwise regular rate, can cause palpitations without tachycardia.
Some key points to consider:
- Palpitations can be regular or irregular, and irregular palpitations may be due to premature depolarizations, AF, or multifocal atrial tachycardia (MAT) 1.
- The diagnosis of supraventricular tachycardia (SVT) is often made in the emergency department, but it is common to elicit symptoms suggestive of SVT before initial electrocardiogram/electrocardiographic (ECG) documentation 1.
- SVT has an impact on quality of life, which varies according to the frequency of episodes, the duration of SVT, and whether symptoms occur not only with exercise but also at rest 1.
- A sustained episode of palpitation lasting for more than a few minutes is often caused by supraventricular arrhythmia, and in patients with frequent palpitations, 48-hour ambulatory electrocardiography should be performed 1.
While palpitations can sometimes signal underlying heart conditions, many cases are benign. If you experience persistent or concerning palpitations, it's advisable to consult a healthcare provider for proper evaluation, which may include an ECG or Holter monitor to determine if tachycardia or other arrhythmias are present. Understanding the difference is important because treatment approaches vary significantly depending on whether actual tachycardia exists.
From the Research
Definition and Causes of Palpitations
- Palpitations are defined as an unpleasant awareness of a beating heart, which can be perceived as fast, irregular, or intense 2.
- They can be caused by various factors, including cardiac arrhythmias, structural heart disease, psychiatric disease, systemic noncardiac disease, and drug or illicit substance assumption 2.
- Palpitations can also be triggered by normal circumstances such as exercise, emotions, and stress, or after taking substances that increase adrenergic tone or diminish vagal activity 3.
Relationship between Palpitations and Tachycardia
- While palpitations are often associated with cardiac rhythm disorders, they are not always indicative of tachycardia 4, 3.
- Tachycardia is a fast heart rate, and some people may experience palpitations due to sinus tachycardia, which is a normal increase in heart rate 3.
- However, palpitations can also be caused by other types of arrhythmias, such as extrasystolic or bradycardic arrhythmias, which are not necessarily associated with a fast heart rate 2.
Diagnosis and Evaluation of Palpitations
- The diagnosis of palpitations can be challenging due to their transitory nature and the fact that patients are often asymptomatic at the time of assessment 4.
- Electrocardiographic monitoring systems, such as 24-hour Holter monitoring, 30-day external continuous monitoring, and implantable loop recorders, can be used to document arrhythmias and aid in diagnosis 5.
- A thorough medical history, physical examination, and 12-lead electrocardiogram (ECG) are also essential in evaluating patients with palpitations 3.