Palpitations

Palpitations are a common symptom in healthy patients. Many patients describe palpitations as ‘heart racing’ or ‘skipped beats.’ The majority of patients with palpitations do not have significant cardiac diseases. Cardiac causes of palpitations in patients can be either benign or worrisome. Sometimes, these serious causes can result in sudden death. In general, palpitations with cardiac causes are due to underlying electrical disturbances or arrhythmia.

Palpitations Q & A 

What causes palpitations? 

Many patients describe palpitations as ‘heart racing’ or ‘skipped beats.’ The majority of patients with palpitations do not have significant cardiac diseases. Examples of non-cardiac causes of palpitations can include:
· Sub-optimal hydration or dehydration
· Sub-optimal regulation of the nervous system (dysautonomia)
· Gastrointestinal / nutritional diseases, i.e. anorexia nervosa, Celiac disease
· Hormone abnormalities, i.e. hyperthyroidism
· Low blood sugar
· Medication side-effects
· Anxiety

Cardiac causes of palpitations in patients can be either benign or worrisome. Sometimes, these serious causes can result in sudden death. In general, palpitations with cardiac causes are due to underlying electrical disturbances or arrhythmia. Examples of cardiac causes of palpitations include:
· Premature (atrial or ventricular) beats
· Long QT Syndrome
· Wolff-Parkinson-White Syndrome
· Brugada Syndrome
· Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

There are also structural heart diseases that are associated with overlapping electrical disturbances:
· Hypertrophic cardiomyopathy
· Arrhythmogenic Right Ventricular Cardiomyopathy
· Mitral valve prolapse
· Ebstein’s anomaly of the tricuspid valve

Cardiac evaluation of palpitations 

To evaluate for the causes of palpitations, the cardiologist will obtain a detailed history to characterize the palpitation and associated symptoms based on trigger, frequency, duration and associated symptoms. The cardiologist will also perform a detailed cardiac examination, order an electrocardiogram (ECG), and may also recommend a cardiac rhythm monitor. If a significant arrhythmia is documented, the patient may be treated with medications or be referred for an electrophysiology specialist evaluation, which can include an electrophysiology study.