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Heart Palpitations – Causes, Symptoms and Treatment

Heart palpitations are the uncomfortable sensation of a fast, pounding, or irregular heartbeat. They can be harmless or indicate an underlying heart condition.

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Things worth knowing about "Heart Palpitations"

Heart palpitations are the uncomfortable sensation of a fast, pounding, or irregular heartbeat. They can be harmless or indicate an underlying heart condition.

What Are Heart Palpitations?

Heart palpitations describe the conscious, often unpleasant awareness of one's own heartbeat. The heart may feel like it is racing, fluttering, pounding, or skipping beats. Medically, a resting heart rate above 100 beats per minute is classified as tachycardia. Palpitations can occur in a normal or elevated heart rate and are typically noticed during rest. While they are frequently harmless and triggered by everyday factors, they can also signal a medical condition that requires evaluation and treatment.

Causes

Heart palpitations have a wide range of potential causes, from benign lifestyle factors to serious cardiac or systemic conditions.

Common Non-Medical Causes

Physical exercise or exertion
Stress, anxiety, or emotional excitement
Caffeine, alcohol, or tobacco consumption
Sleep deprivation or fatigue
Certain medications (e.g., bronchodilators, thyroid hormones, decongestants)
Fever or acute infections
Dehydration

Medical Causes

Cardiac arrhythmias such as atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT)
Hyperthyroidism (overactive thyroid gland)
Anemia (low red blood cell count)
Low blood pressure (hypotension)
Heart conditions such as heart failure or valvular heart disease
Electrolyte imbalances (e.g., low potassium or magnesium)
Panic attacks and anxiety disorders

Symptoms

Palpitations may occur alone or alongside other symptoms that can help identify the underlying cause:

Racing, fluttering, or irregular heartbeat
Sensation of skipped or extra heartbeats
Dizziness or lightheadedness
Shortness of breath
Chest pain or tightness
Feeling of anxiety or nervousness
Fainting or temporary loss of consciousness (in severe cases)

Diagnosis

A thorough evaluation is important to determine the cause of heart palpitations. Diagnostic steps may include:

Medical history: Questions about frequency, duration, triggers, and associated symptoms
Electrocardiogram (ECG): Records the electrical activity of the heart at rest
Holter monitor (ambulatory ECG): Continuous heart rhythm monitoring over 24–48 hours during daily activities
Echocardiography: Ultrasound imaging of the heart to assess structure and function
Blood tests: Evaluation of thyroid function, blood count, electrolytes, and other parameters
Exercise stress test: Assessment of heart rhythm during physical exertion

Treatment

Treatment depends on the underlying cause of the palpitations.

Lifestyle Modifications

Reducing or eliminating caffeine, alcohol, and tobacco
Managing stress through relaxation techniques, yoga, or meditation
Ensuring adequate sleep and hydration
Avoiding known personal triggers

Medical Treatment

Beta-blockers: Slow the heart rate and are commonly prescribed for tachycardia
Antiarrhythmic drugs: Medications that help restore or maintain a normal heart rhythm
Treating the underlying condition, such as thyroid medication for hyperthyroidism

Interventional Procedures

Cardioversion: Electrical or pharmacological restoration of normal heart rhythm
Catheter ablation: A minimally invasive procedure to eliminate abnormal electrical pathways in the heart
Pacemaker or implantable defibrillator (ICD): Used in cases of severe or life-threatening arrhythmias

When to See a Doctor

Occasional, brief palpitations without other symptoms are usually not a cause for concern. However, medical attention should be sought promptly if palpitations are accompanied by:

Chest pain or pressure
Dizziness or fainting
Prolonged or frequently recurring episodes
Onset at rest without an identifiable trigger
A known history of heart disease

References

Zipes DP, Jalife J - Cardiac Electrophysiology: From Cell to Bedside. 7th edition, Elsevier, 2018.
Camm AJ et al. - 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal, 2021; 42(5): 373–498.
American Heart Association - Palpitations: Symptoms, Diagnosis and Monitoring. Dallas, 2023. Available at: https://www.heart.org

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