13.1 Basics

Definition

Palpitations are defined as the unpleasant awareness of your own heartbeat. Palpitations are often described by patients as pounding or skipping a beat. The heartbeat is perceived to be unpleasant when it is especially rapid or irregular or when individual heartbeats are unusually strong. However, individuals’ awareness of their own heartbeat varies greatly.

Etiology

Frequently, no organic cause for palpitations is found, but palpitations can be an indication of a relevant underlying rhythm disorder. Some of the cardiac diseases frequently associated with arrhythmias are:

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  Status post correction of a congenital heart defect (especially after Fontan procedure or Mustard/Senning atrial baffle procedure)

  
  
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  Hypertrophic obstructive cardiomyopathy

  
  
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  Dilated cardiomyopathy

  
  
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  Aortic stenosis

  
  
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  Heart failure

  
  
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  Cardiac tumor

  
  
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  Myocarditis

  
  
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  Mitral valve prolapse

In addition to cardiac causes of arrhythmia, numerous noncardiac causes can lead to palpitations, for example, hyperthyroidism or anemia. Other causes may be stimulants (caffeine, nicotine), drugs, or medication. Psychiatric disorders such as panic attacks or anxiety must also be ruled out. Palpitations can be physiological in association with exertion, agitation, or fever.

The most frequent causes of palpitations are listed in Table 13.1.