What are the common causes of cardiac palpitations (arrhythmias)?

From the Guidelines

Cardiac palpitations are commonly caused by reversible conditions such as alcohol intake, surgery, electrocution, MI, pericarditis, myocarditis, pulmonary embolism, hyperthyroidism, and other metabolic disorders, as well as stress, anxiety, caffeine consumption, nicotine, and certain medications. According to the most recent study 1, atrial fibrillation (AF) is a supraventricular tachyarrhythmia that can be caused by various factors, including acute temporary causes such as excessive alcohol intake, surgery, pericarditis, myocarditis, hyperthyroidism, and pulmonary embolism. Some key points to consider when evaluating the causes of cardiac palpitations include:

• Reversible causes of atrial fibrillation, such as those mentioned above, which can often be treated by addressing the underlying condition 1
• The role of stress and anxiety in triggering the release of stress hormones like adrenaline, which can increase heart rate 1
• The potential for certain medications, including decongestants, asthma inhalers, and some antidepressants, to cause palpitations as a side effect 1
• The importance of considering medical conditions such as thyroid disorders, anemia, low blood sugar, fever, dehydration, electrolyte imbalances, and heart conditions like arrhythmias, which can also cause palpitations 1 It is essential to note that if you experience frequent or severe palpitations, especially with chest pain, dizziness, shortness of breath, or fainting, you should seek medical attention immediately, as these could indicate a serious heart condition requiring treatment. The study 1 highlights the significance of drug-induced atrial fibrillation, which can be caused by a range of medications, including cardiovascular, non-cardiovascular, and anticancer drugs, and can increase the risk of developing AF. Overall, the most critical step in managing cardiac palpitations is to identify and address any underlying reversible causes, and to seek medical attention if symptoms persist or worsen.

From the Research

Common Causes of Cardiac Palpitations

The common causes of cardiac palpitations (arrhythmias) can be summarized as follows:

• Cardiac arrhythmias, such as sinus tachycardia, atrial fibrillation, premature ventricular contractions, or ventricular tachycardia 2, 3
• Anxiety-induced sinus tachycardia 2
• Structural heart disease, such as mitral valve prolapse, pericarditis, and congestive heart failure 3, 4
• Noncardiac problems, such as hyperthyroidism, vasovagal syncope, and hypoglycemia 3
• Stimulant drugs, and over-the-counter and prescription medications 3
• Psychiatric disease 4
• Systemic noncardiac disease 4
• Drug or illicit substance assumption 4

Specific Causes of Palpitations

Some specific causes of palpitations include:

• Wolff-Parkinson-White syndrome or other forms of re-entrant tachycardia, especially in young women 5
• Paroxysmal supraventricular tachycardia, which may be related to ovarian hormones or mechanical stimuli during pregnancy 5
• Mitral valve prolapse, which can cause palpitations, especially in women 5
• Increased sympathetic activity caused by the menopause, which can lead to palpitations during the perimenopausal period 5

Diagnosis and Treatment

The diagnosis and treatment of palpitations depend on the underlying cause, and may involve:

• Ambulatory electrocardiographic (ECG) monitoring 3
• Holter monitoring for 24 to 48 hours 3
• Trans-telephonic event monitors 3
• Electrophysiological studies 5
• Catheter ablation for certain types of arrhythmias, such as Wolff-Parkinson-White syndrome 5
• Treatment of underlying conditions, such as anxiety or structural heart disease 2, 3, 4, 5