I. Definition
Palpitation is one of the most common cardiac symptoms encountered in medical practice but it poorly corresponds to demonstrable abnormalities. The term palpitation is used loosely to describe an unpleasant subjective awareness of one’s own heartbeats. This usually occurs as a sensation in the chest of rapid, irregular, or unusually strong heartbeats.
II. Causes
Many palpitations are often not serious, but they may indicate the possible presence of serious cardiac arrhythmias. Box 22.1 lists causes of palpitation.
- 1.
A high percentage of patients with palpitation have no etiology that can be established.
- 2.
Certain stimulants, such as caffeine, can be identified as a cause of palpitation. Caffeine is found in many foods and drinks, such as coffee, tea, hot cocoa, soda, and chocolate, as well as in some medicines. Most energy drinks (such as Venom, Whoopass, Red Bull, Adrenalin Rush) contain large doses of caffeine and other legal stimulants, including ephedrine, guarana, taurine, and ginseng.
- 3.
Certain drugs, prescription or over-the-counter, can be identified as a cause of palpitation.
- 4.
Some medical conditions, such as hyperthyroidism, anemia, and hypoglycemia, may be the cause of palpitation.
- 5.
Rarely, slow heart rates may cause palpitation.
- 6.
Some patients report palpitation while having sinus tachycardia.
- 7.
Rarely, cardiac arrhythmias should be looked into as a cause of palpitation, although most arrhythmias are not perceived and reported as palpitations.
- 8.
Occasionally, a psychogenic or psychiatric cause for the symptoms can be suspected. Some adult patients with palpitations have panic disorder or panic attack.
Normal physiologic event
Exercise, excitement, fever
Psychogenic or psychiatric
Fear, anger, stress, anxiety disorders, panic attack or panic disorder
Certain drugs and substances
Stimulants: caffeine (coffee, tea, soda, chocolate), some energy drinks, smoking
Over-the-counter drugs: decongestants, diet pills, etc.
Drugs that cause tachycardia: catecholamines, theophylline, hydralazine, minoxidil, cocaine
Drugs that cause bradycardia: β-blockers, antihypertensive drugs, calcium channel blockers
Drugs that cause arrhythmias: antiarrhythmics (some of which are proarrhythmic), tricyclic antidepressants, phenothiazines
Certain medical conditions
Anemia
Hyperthyroidism
Hypertension
Pheochromocytoma (with catecholamine excess)
Hypoglycemia
Hyperventilation
Poor physical condition
Heart diseases
Certain CHDs that are prone to arrhythmias or result in poor physical condition
Following surgeries for CHD: Fontan connection, Senning operation
Mitral valve prolapse
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Cardiac tumors or infiltrative diseases
Cardiac arrhythmias
Tachycardias: sinus tachycardia, SVT, VT
Bradycardia
Premature beats: PACs, PVCs
Atrial fibrillation
Sick sinus syndrome
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