Palpitations, characterized by an abnormal awareness of your own heartbeat, are a prevalent complaint across all age groups and demographics in outpatient settings. While most palpitations arise from non-arrhythmic causes during normal sinus rhythm, it’s crucial to understand the spectrum of potential diagnoses.
A significant portion of palpitations are linked to treatable cardiac conditions that are not immediately life-threatening. These include premature ventricular contractions (PVCs) and premature atrial contractions (PACs), as well as supraventricular tachycardias (SVTs). Common SVTs include atrial fibrillation, atrial flutter, atrioventricular nodal re-entry tachycardia (AVNRT), atrial tachycardia, and atrioventricular re-entry tachycardia, often associated with Wolff-Parkinson-White syndrome. Interestingly, sinus rhythm is frequently observed when patients are evaluated for palpitations. This heightened awareness of a normal heartbeat can be triggered by emotional or physical stress, or by the consumption of substances like caffeine, alcohol, or other stimulants.
However, it’s essential to recognize that palpitations can sometimes be a manifestation of serious, potentially life-threatening conditions, especially in individuals with structural heart disease. Ventricular tachycardia (VT), for instance, is a dangerous arrhythmia that can lead to sudden cardiac death. Inherited cardiac conditions such as hypertrophic cardiomyopathy, Brugada syndrome, and long QT syndrome can also initially present with palpitations and carry a risk of sudden cardiac death.
Palpitations accompanied by syncope (fainting) are particularly concerning. These instances are more likely to be associated with malignant arrhythmias like ventricular tachycardia and necessitate urgent medical evaluation.
The diagnostic evaluation of palpitations begins with a thorough and focused medical history, a physical examination, and a standard 12-lead electrocardiogram (ECG). Further investigations and treatment strategies are guided by these initial findings. Ambulatory electrocardiographic monitoring, such as Holter monitoring or event recorders, and electrophysiological testing may be necessary to determine the underlying cause of palpitations and guide appropriate management.
