Do any of the following commonly cause cardiac palpitations:

From the Guidelines

Yes, several factors commonly cause cardiac palpitations, including caffeine, nicotine, alcohol, certain medications, anxiety, stress, hormonal changes, and electrolyte imbalances. These factors can stimulate the heart and nervous system, increase heart rate, and disrupt normal heart rhythm, leading to palpitations. According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, nondihydropyridines calcium channel blockers, and some antiarrhythmic medications may relieve symptoms of palpitations. Some key factors that can cause palpitations include:

• Caffeine consumption, which can stimulate the heart and nervous system
• Nicotine in tobacco products, which can increase heart rate
• Alcohol consumption, particularly binge drinking or withdrawal, which can disrupt normal heart rhythm
• Certain medications, such as decongestants containing pseudoephedrine, asthma inhalers (especially albuterol), thyroid medications at high doses, and some antidepressants, which can trigger palpitations as side effects
• Anxiety, stress, and panic attacks, which can activate the body's fight-or-flight response and increase heart rate
• Hormonal changes during menstruation, pregnancy, or menopause, which can affect heart rhythm in some women
• Electrolyte imbalances, particularly low potassium or magnesium levels, which can interfere with normal electrical signaling in the heart. It is essential to note that while occasional palpitations from these causes are usually harmless, persistent or severe palpitations should be evaluated by a healthcare provider to rule out underlying heart conditions, as stated in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.

From the FDA Drug Label

Cardiovascular Shortness of breath and bradycardia have occurred in approximately 3 of 100 patients. Cold extremities; arterial insufficiency, usually of the Raynaud type; palpitations; congestive heart failure; peripheral edema; and hypotension have been reported in about 1 of 100 patients 2

Palpitations are reported as an adverse reaction in approximately 1 of 100 patients taking metoprolol.

• Metoprolol may cause cardiac palpitations. No information is available for amiodarone that directly supports the answer to the question.

From the Research

Common Causes of Cardiac Palpitations

• Cardiac arrhythmias, such as sinus tachycardia, atrial fibrillation, premature ventricular contractions, or ventricular tachycardia, can cause palpitations 3, 4, 5
• Nonarrhythmic cardiac problems, including mitral valve prolapse, pericarditis, and congestive heart failure, can also lead to palpitations 3
• Noncardiac issues, such as hyperthyroidism, vasovagal syncope, and hypoglycemia, may cause palpitations 3, 5
• Stimulant drugs and certain over-the-counter and prescription medications can trigger palpitations 3

Specific Arrhythmias and Their Associations with Palpitations

• Premature atrial contractions (PACs) can cause palpitations, and frequent PACs may be associated with the development of atrial fibrillation 5
• Premature ventricular contractions (PVCs) are common and can lead to palpitations, especially in patients with underlying heart disease 5
• Supraventricular tachycardia is a common arrhythmia that can cause palpitations, and treatment options include cardioversion, catheter ablation, or medical antiarrhythmics 5
• Sinus node dysfunction can cause various rhythm disturbances, including bradycardia and tachycardia, leading to palpitations 5

Evaluation and Management of Palpitations

• A thorough patient history, physical examination, and basic electrocardiogram are essential in evaluating palpitations and determining the underlying cause 3, 4, 6
• Various outpatient evaluation tools, such as Holter monitors, event monitors, and echocardiography, can be used to diagnose and manage palpitations 3, 6
• In some cases, hospital admission may be necessary to complete the diagnostic workup, especially if the patient is hemodynamically compromised 6