Palpitation is 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. The patient describes it as pounding, jumping, racing, irregularity of the heartbeat, a “flip flopping” or “rapid fluttering“ in the chest, or pounding in the neck. Palpitation can be felt in the chest, throat, or neck. The pulse rate may become faster or rarely slower than normal. The term palpitation is used so loosely that specific questions must be asked to determine the exact nature of the symptom.


Palpitation is one of the most common cardiac symptoms encountered in medical practice, but it poorly corresponds to demonstrable abnormalities. Many palpitations are not serious. However, palpitation may indicate the possible presence of serious cardiac arrhythmias.

Box 32-1 lists causes of palpitation. The differential diagnosis can range from benign etiologies to life-threatening arrhythmias.

  • A high percentage of patients with palpitation have no cause that can be established.

  • Caffeine, a common stimulant, is found in many foods and drinks, such as coffee, tea, hot cocoa, soda, chocolate, and some medicines. Most energy drinks (e.g., Venom, Whoopass, Red Bull, Adrenalin Rush), which are the latest popular fad among youth, contain large doses of caffeine and other legal stimulants, including ephedrine, guarana, taurine, and ginseng.

  • Certain drugs and substances can be identified as causes of palpitation.

  • Some medical conditions, such as hyperthyroidism, anemia, and hypoglycemia, may be the cause of palpitation.

  • Although relatively rare, cardiac arrhythmias and structural heart disease should be looked into as a cause of palpitation. However, most palpitations are not accompanied by arrhythmias, and most arrhythmias are not perceived and reported as palpitations.

  • Rarely, slow heart rates may cause palpitation.

  • Occasionally, a psychogenic or psychiatric cause for the symptoms can be suspected. Some adult patients and adolescents with palpitations have panic disorder or panic attack. Panic attack and arrhythmias may be difficult to distinguish clinically because both may present as palpitations, shortness of breath, and lightheadedness.

BOX 32-1

Normal Physiologic Events

Exercise, excitement, fever

Psychologic 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, and so on

Drugs that cause tachycardia: catecholamines, theophylline, hydralazine, minoxidil, cocaine

Drugs that cause bradycardia: beta-blockers, antihypertensive drugs, calcium channel blockers

Drugs that cause arrhythmias: antiarrhythmics (some of which are proarrhythmic), tricyclic antidepressants, phenothiazines

Certain Medical Conditions





Poor physical condition

Heart Diseases

Certain congenital heart defects that are prone to arrhythmias or that result in a poor physical condition

After surgeries for congenital heart disease: Fontan connection, Senning operation

Mitral valve prolapse

Hypertrophic cardiomyopathy

Dilated cardiomyopathy

Valvular disease: aortic stenosis

Cardiac tumors or infiltrative diseases

Cardiac Arrhythmias



Premature atrial contractions

Premature ventricular contractions

Supraventricular tachycardias

Ventricular tachycardias

Atrial fibrillation

Wolff-Parkinson-White preexcitation

Sick sinus syndrome

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Apr 15, 2019 | Posted by in CARDIOLOGY | Comments Off on Palpitation

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