From the Guidelines
You should seek medical help for palpitations immediately if they are accompanied by chest pain, shortness of breath, dizziness, fainting, or severe anxiety, as these symptoms may indicate a life-threatening condition. Additionally, seek urgent care if palpitations are persistent, worsening over time, or occur with a history of heart disease. While occasional palpitations lasting a few seconds are usually harmless and often triggered by caffeine, stress, or certain medications, prolonged episodes or those causing significant symptoms warrant professional evaluation.
Key Considerations
- If you experience new or concerning palpitations, contact your healthcare provider, who may recommend tests such as an ECG, Holter monitor, or echocardiogram to determine the cause, as suggested by 1.
- Palpitations can result from benign causes like anxiety or dehydration, but they can also indicate arrhythmias or structural heart problems that require treatment.
- People with existing heart conditions should have a lower threshold for seeking help, as palpitations might indicate a change in their condition requiring medication adjustment or other interventions, as noted in 1 and 1.
Evaluation and Management
- A 12-lead ECG obtained during tachycardia and during sinus rhythm may reveal the etiology of tachycardia, as stated in 1.
- For patients presenting with supraventricular tachycardia (SVT), the 12-lead ECG can potentially identify the arrhythmia mechanism, and further evaluation by a cardiac electrophysiologist may be necessary, as recommended in 1.
- Patients with suspected acute coronary syndrome (ACS) and high-risk features such as continuing chest pain, severe dyspnea, syncope/presyncope, or palpitations should be referred immediately to the emergency department (ED) and transported by emergency medical services when available, as advised in 1.
From the Research
When to Seek Medical Help for Cardiac Palpitations
- Palpitations can be a common complaint that can occur under normal or abnormal circumstances, such as with exercise, emotions, and stress, or after taking substances that increase adrenergic tone or diminish vagal activity 2
- Abnormal palpitations, which can be fast, strong and slow, or feel like a missed or extra beat, usually point to a cardiac arrhythmia, but this is not always the case 2
- Patients with arrhythmias may not have palpitations, but instead may experience manifestations such as syncope, shock, and chest pain, and in severe cases, sudden death 2
Evaluation and Management
- A detailed history, physical examination, and electrocardiogram (ECG) are essential in evaluating patients with palpitations, and can yield a probable diagnosis 3
- Limited laboratory testing, ambulatory ECG monitoring, and cardiology referral may be indicated in some cases 3
- A step-wise guide to the evaluation and management of palpitations can help identify patients at highest risk for serious arrhythmias 4
Treatment Options
- Medical treatment, primarily beta-blockers (BB) or calcium channel blockers (CCB), may be beneficial for patients with symptomatic and frequent premature ventricular contractions (PVCs) 5
- The choice of treatment may depend on patient and electrocardiography (ECG) characteristics, such as demographic and ECG characteristics, left ventricular ejection fraction, and PVC burden 5
Importance of Medical Attention
- Palpitations can be associated with considerable disability, distress, and concern about heart disease, and can be a manifestation of potentially life-threatening conditions 6
- Seeking medical attention is crucial to determine the underlying cause of palpitations and to receive appropriate treatment and management 2, 6, 3, 4