13 Palpitations


13 Palpitations

13.1 Basics


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.


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:

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

  • Hypertrophic obstructive cardiomyopathy

  • Dilated cardiomyopathy

  • Aortic stenosis

  • Heart failure

  • Cardiac tumor

  • Myocarditis

  • 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.

Table 13.1 Frequent causes of palpitations

Physiological causes

  • Physical or emotional stress, agitation

  • Fever

Cardiac causes

  • Extrasystoles (supraventricular, ventricular)

  • Paroxysmal tachycardias such as AV nodal re-entrant tachycardia or AV re-entrant tachycardia (WPW syndrome)

  • Other tachycardias (sinus tachycardia, postural tachycardia syndrome)

  • Bradycardias (sinus node dysfunction, AV blocks)

  • Atrial fibrillation (absolute arrhythmia)

Psychogenic causes and psychiatric disorders

  • Anxiety, panic attacks

  • Hyperventilation

Medication and drugs

  • Stimulants: caffeine, nicotine, energy drinks

  • Medication that can lead to tachycardia (catecholamines, betamimetics, theophylline, thyroid hormones, abrupt discontinuation of beta blockers)

  • Medication that can lead to bradycardia (beta blockers, calcium antagonists)

  • Potentially arrhythmogenic medication (antiarrhythmics, antidepressants)

Metabolic disorders

  • Hyperthyroidism

  • Hypoglycemia

Other causes

  • Anemia

  • Poor physical condition

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jun 13, 2020 | Posted by in CARDIOLOGY | Comments Off on 13 Palpitations

Full access? Get Clinical Tree

Get Clinical Tree app for offline access