Palpitations: a proper evaluation and approach to effective medical therapy
Abstract
Palpitations are a common complaint seen in the outpatient setting and the vast majority are benign, although they are occasionally a manifestation of potentially life-threatening conditions. We offer a step-wise guide to the evaluation and management of these patients with the primary goal to identify patients at highest risk for serious arrhythmias. We offer a brief overview of effective management of the varied causes of palpitations.
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According to the aetiological hierarchy, non-arrhythmic causes of palpitations emerge as definitive diagnoses only in cases in which the symptom-ECG correlation excludes the presence of rhythm disorders.
“Thus, according to this aetiological hierarchy, non-arrhythmic causes of palpitations emerge as definitive diagnoses only in cases in which the symptom-electrocardiogram (ECG) correlation excludes the presence of rhythm disorders.8”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
The causes of palpitations can be subdivided into five main groups: cardiac arrhythmias, structural heart diseases, psychosomatic disorders, systemic diseases, and effects of medical and recreational drugs.
“From the aetiological point of view, the causes of palpitations can be subdivided into five main groups (Table 1): cardiac arrhythmias, structural heart diseases, psychosomatic disorders, systemic diseases, and effects of medical and recreational drugs.3 -9”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
It is not always possible to establish a definite cause of palpitations; often, only a likely cause can be given, and, in some cases, several possible causes have to be taken into consideration.
“Indeed, it is not always possible to establish a definite cause of palpitations; often, only a likely cause can be given, and, in some cases, several possible causes have to be taken into consideration.8,42”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
Clinical characteristics of the patient, such as age, presence of heart disease, and ECG abnormalities, do not always allow the physician to identify a priori those cases in which palpitations are caused by clinically significant rhythm disorders.
“Moreover, clinical characteristics of the patient, such as age, presence of heart disease, and ECG abnormalities, do not always allow the physician to identify a priori those cases in which palpitations are caused by clinically significant rhythm disorders.8,47,48,52 -54”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
The most common descriptions, and those most useful in clinical practice in differential diagnoses among the various causes of palpitations, enable palpitations to be classified according to the rate, rhythm, and intensity of heartbeat: extrasystolic palpitations, tachycardiac palpitations, anxiety-related palpitations, and pulsation palpitations.
“The most common descriptions, and those most useful in clinical practice in differential diagnoses among the various causes of palpitations, enable palpitations to be classified according to the rate, rhythm, and intensity of heartbeat 5 -9,59,60 : extrasystolic palpitations, tachycardiac palpitations, anxiety-related palpitations, and pulsation palpitations (Table 2).”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
Certain symptoms and circumstances associated to palpitations are often connected with the various causes of the palpitations and may be very helpful in making differential diagnoses.
“Certain symptoms and circumstances associated to palpitations are often connected with the various causes of the palpitations and may be very helpful in making differential diagnoses.5 -9,59,60”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [8]
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References 34 · Cited by 9
- Authors
- Pickett, C. C., & Zimetbaum, P. J.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- ORCID
- Zimetbaum, Peter J.
- Venue
- Current Cardiology Reports
- Published
- 2005-09
- Volume
- 7
- Issue
- 5
- Pages
- 362-367
- ISSN
- 1523-3782 (ISSN-L)
- 1534-3170
- OpenAlex
- W2035712384
- Cited by
- 9
- References
- 34
- Citations by year
- 2025: 1 · 2018: 1 · 2016: 1 · 2012: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Cardiology Reports (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- palpitations, arrhythmia evaluation, arrhythmia management, risk stratification, malignant arrhythmias, outpatient cardiology, medical therapy
- MeSH terms
- Humans, Tachycardia, Electrocardiography, Ambulatory
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