From the Guidelines
Heart palpitations are sensations of rapid, irregular, or forceful heartbeats that can be caused by various factors, and management depends on the underlying cause and severity, with the most recent guidelines from 2015 emphasizing the importance of catheter ablation for certain types of supraventricular tachycardia 1.
Causes of Heart Palpitations
- Stress, anxiety, caffeine, alcohol, nicotine, certain medications, hormonal changes, electrolyte imbalances, thyroid disorders, heart disease, and arrhythmias are common causes of heart palpitations.
- Premature beats are commonly described as pauses or nonconducted beats followed by a sensation of a strong heart beat, or they are described as irregularities in heart rhythm 1.
- Supraventricular tachycardias occur in all age groups and may be associated with minimal symptoms, such as palpitations, or they may present with syncope 1.
Management of Heart Palpitations
- For mild, occasional palpitations related to lifestyle factors, reducing caffeine and alcohol intake, managing stress through relaxation techniques, getting adequate sleep, and avoiding triggers can help.
- Beta-blockers like metoprolol (25-100 mg daily) or propranolol (10-40 mg twice daily) can be prescribed to slow heart rate, and anti-arrhythmic medications such as flecainide or amiodarone can be used for specific rhythm disorders 1.
- For severe cases or certain arrhythmias, procedures like cardioversion, catheter ablation, or pacemaker implantation might be necessary, with catheter ablation being a highly effective treatment option for certain types of supraventricular tachycardia 1.
- It's essential to seek immediate medical attention if palpitations are accompanied by chest pain, severe shortness of breath, dizziness, or fainting, as these could indicate a serious condition requiring urgent treatment.
Importance of Clinical History and Physical Examination
- A clinical history describing the pattern of palpitations, including the number of episodes, duration, frequency, mode of onset, and possible triggers, is crucial in determining the underlying cause and guiding management decisions 1.
- The clinician should distinguish whether the palpitations are regular or irregular, as irregular palpitations may be due to premature depolarizations, AF, or multifocal atrial tachycardia (MAT) 1.
From the Research
Causes of Heart Palpitations
- Heart palpitations can be caused by cardiac arrhythmias or anxiety, with any arrhythmia, including sinus tachycardia, atrial fibrillation, premature ventricular contractions, or ventricular tachycardia, potentially causing palpitations 2
- Nonarrhythmic cardiac problems, such as mitral valve prolapse, pericarditis, and congestive heart failure, and noncardiac problems, such as hyperthyroidism, vasovagal syncope, and hypoglycemia, can also cause palpitations 2
- Stimulant drugs, and over-the-counter and prescription medications can also lead to palpitations 2
Management of Heart Palpitations
- Ambulatory electrocardiographic (ECG) monitoring is usually indicated if the etiology of palpitations cannot be determined from the patient's history, physical examination, and resting ECG 2
- A 12-lead electrographic (ECG) monitor on presentation is the gold standard of diagnosis, and if the aetiology cannot be determined, an ambulatory Holter 24-48-h monitor can be used 3
- Trans-telephonic event monitors are more effective and cost-effective than Holter monitors for most patients, and can provide a clear diagnosis more quickly 4
- Treatment and follow-up of patients presenting with palpitations as the main complaint will depend on the aetiology and investigation findings, with patients with palpitations accompanied by dizziness, excessive fatigue, or chest pains requiring adequate acute care 3
Diagnostic Approaches
- A thorough history and physical examination, followed by targeted diagnostic testing, can distinguish cardiac conditions from other causes of palpitations 5
- Persons with a history of cardiovascular disease, palpitations at work, or palpitations that affect sleep have an increased risk of a cardiac cause, and should undergo a more in-depth evaluation for heart disease 5
- Cardiac event recording can yield more diagnoses than 24-hour Holter monitoring in patients with palpitations, and is a useful diagnostic tool 4