Palpitations, the sensation of feeling your own heart beating, can be a benign or a symptom of a more serious cardiac condition. Here’s a detailed overview:
Causes
- Cardiac Arrhythmias: Such as atrial fibrillation, supraventricular tachycardia, ventricular tachycardia.
- Psychological Factors: Stress, anxiety, panic attacks.
- Lifestyle Factors: Excessive caffeine or alcohol intake, smoking, drug use (e.g., cocaine).
- Hormonal Changes: Thyroid disorders (hyperthyroidism), pregnancy, menopause.
- Medication Side Effects: Decongestants, beta-agonists, some antidepressants.
- Heart Conditions: Heart failure, heart valve diseases.
- Other Medical Conditions: Anemia, dehydration, low blood sugar.
Diagnosis
- History:
- Character of palpitations (rapid, skipping, fluttering).
- Duration, frequency, and triggers.
- Associated symptoms (dizziness, chest pain, shortness of breath).
- Medical, psychiatric, and family history.
- Substance use (caffeine, alcohol, drugs).
- Current medications.
- Physical Examination:
- Heart rate and rhythm, blood pressure.
- Cardiac examination for murmurs, extra heart sounds, rhythm irregularities.
- Thyroid examination.
- Looking for signs of anemia or dehydration.
- Investigations:
- Blood Tests: Thyroid function tests, electrolytes, complete blood count.
- Electrocardiogram (ECG): To detect arrhythmias, ischemia, or other heart problems.
- Holter Monitor or Event Monitor: For intermittent palpitations not captured by ECG.
- Echocardiogram: To assess structural heart disease.
- Stress Testing: If ischemic heart disease is suspected.
Differential Diagnosis
- Arrhythmias: Different types based on ECG findings.
- Anxiety or Panic Disorders: Particularly in young patients with stress triggers.
- Hyperthyroidism: Palpitations with weight loss, heat intolerance.
- Heart Valve Diseases: Murmurs noted on examination.
- Substance or Medication-Induced: History of substance use or new medications.
Management
- Lifestyle Modification:
- Reduce or eliminate caffeine, alcohol, and smoking.
- Stress management and relaxation techniques.
- Treating Underlying Cause:
- Addressing arrhythmias with medication, cardioversion, or ablation.
- Treating anxiety or depression with therapy or medication.
- Managing thyroid disorders or other systemic causes.
- Medications:
- Beta-blockers or calcium channel blockers for certain types of arrhythmias.
- Antiarrhythmic medications for more complex arrhythmias.
- Patient Education:
- Understanding what triggers palpitations.
- Recognizing signs of more serious heart conditions.
- Regular Monitoring:
- Follow-up appointments to monitor progress and response to treatment.
- Periodic reevaluation if symptoms change or worsen.
- Referral:
- Cardiology referral for complex arrhythmias or structural heart disease.
- Endocrinology referral for thyroid disorders.
- Emergency Management:
- Seek immediate care for palpitations with chest pain, severe shortness of breath, or syncope.
Conclusion
Palpitations are a common symptom with a wide range of causes. A thorough clinical evaluation is essential to determine the underlying cause and guide management. In many cases, palpitations are benign, but they can be a sign of a more serious condition, necessitating a careful and systematic approach to diagnosis and treatment.