Palpitations

Question 1

Definition

Answer 1

Increased awareness of heartbeat/ rapid pulsations or abnormally rapid or irregular beating of the heart.

Question 2

Aetiology/ causes

Answer 2

Clinical presentation can be divided into four groups (extra-systolic, tachycardic, anxiety-related, and intense (anxiety-related is the most common)

Patients who describe the palpitations as a brief flip-flopping in the chest, the palpitations are thought to be caused by extra systoles such as supra-ventricular or ventricular premature contractions.

Strong emotional responses, such as stress, anxiety or panic attacks

Depression
Fever

Hormone changes associated with menstruation, pregnancy or menopause

Too much or too little thyroid hormone

Question 3

Risk factors

Answer 3

Lifestyle triggers such as strenuous exercise
Effects of medical and recreational drugs
Excessive tobacco, alcohol or caffeine use
Certain medications
Anxiety

Question 4

Epidemiology/ Population affected

Answer 4

Very common in the general population

Especially those affected by structural heart disease

Question 5

Clinical presentation

Answer 5

flip-flopping in the chest, a rapid fluttering in the chest, or pounding in the neck.

Palpitations induced by exercise could be suggestive of cardiomyopathy, ischaemia or channelopathies

Question 6

Prognosis

Answer 6

Most palpitations will not require treatment and subside spontaneously (avoid triggers)

Question 7

DDX

Answer 7

Arrhythmias
Atrial fibrillation/flutter

Bradycardia caused by advanced atriovenous block or sinus node dysfunction

Bradycardia-tachycardia syndrome
Multifocal atrial tachycardia

Premature supra-ventricular or ventricular contractions

Sinus tachycardia or arrhythmia
Supra-ventricular tachycardia
Ventricular tachycardia
Wolff-Parkinson-white syndrome