What are examples of conditions that can cause palpitations across different categories, including cardiovascular, psychiatric, medications, substances, endocrinologic, hematologic, and infectious?

Conditions That Can Cause Palpitations Across Different Categories

Palpitations can be caused by a wide range of conditions across multiple body systems, with cardiovascular causes being the most concerning due to their potential impact on morbidity and mortality. 1

Cardiovascular Causes

• Arrhythmias:

  • Premature ventricular contractions (PVCs)
  • Premature atrial contractions (PACs)
  • Atrial fibrillation
  • Atrial flutter
  • Supraventricular tachycardia (SVT)
  • Ventricular tachycardia
  • Sinus tachycardia
  • Wolff-Parkinson-White syndrome
  • Sick sinus syndrome

• Structural Heart Disease:

  • Valvular heart disease (especially mitral valve prolapse)
  • Cardiomyopathies (hypertrophic, dilated, restrictive)
  • Congenital heart disease
  • Left ventricular noncompaction
  • Takotsubo cardiomyopathy

• Other Cardiovascular Conditions:

  • Coronary artery disease
  • Heart failure
  • Pericarditis
  • Pulmonary embolism
  • Pulmonary arterial hypertension
  • Anomalous coronary artery 1

Psychiatric Causes

• Anxiety disorders
• Panic attacks
• Depression
• Somatization disorders
• Post-traumatic stress disorder
• Generalized anxiety disorder 1, 2

Medication-Related Causes

• Sympathomimetics:

  • Beta-agonists (e.g., salbutamol/albuterol)
  • Decongestants (pseudoephedrine)
  • Stimulants (methylphenidate, amphetamines)

• Antiarrhythmics (paradoxical effect)

• Other Medications:

  • Thyroid supplements (excessive doses)
  • Anticholinergics
  • Some antibiotics (fluoroquinolones)
  • Antipsychotics
  • Antihistamines
  • Medications causing QT prolongation 1, 3

Substance-Related Causes

• Caffeine
• Alcohol (both intoxication and withdrawal)
• Nicotine
• Cocaine
• Amphetamines
• Energy drinks
• Marijuana
• Anabolic steroids
• Illicit drugs 1, 4

Endocrinologic Causes

• Hyperthyroidism
• Hypothyroidism
• Pheochromocytoma
• Carcinoid syndrome
• Hypoglycemia
• Hyperadrenergic states
• Menopause-related hormonal changes
• Pregnancy-related hormonal changes 5, 2

Hematologic Causes

• Anemia
• Polycythemia
• Thrombocytosis
• Leukemia
• Hemochromatosis (systemic iron deposition)
• Blood loss/hypovolemia 1

Infectious Causes

• Myocarditis
• Endocarditis
• Pericarditis
• Lyme disease (particularly Lyme carditis)
• Chagas disease
• Systemic infections with fever
• Sepsis 1

Key Clinical Considerations

1. Palpitations associated with syncope, near-syncope, chest pain, or dyspnea warrant urgent evaluation due to increased risk of serious cardiac causes 1.

2. Patients with structural heart disease who experience palpitations have a higher risk of life-threatening arrhythmias and should undergo comprehensive cardiac evaluation 1.

3. The pattern of palpitations (regular vs. irregular, sustained vs. brief, associated symptoms) can provide important diagnostic clues 1, 2.

4. Ambulatory cardiac monitoring is often necessary to correlate symptoms with cardiac rhythm, especially when the cause is not apparent from history, physical examination, and resting ECG 1, 2.

5. Palpitations that occur during exercise or that worsen with exertion may indicate a more serious underlying cardiac condition 1.

6. Medication and substance history is crucial, as many commonly used medications and substances can trigger palpitations 3.