Investigation of palpitations
Abstract
The uncomfortable awareness of a beating heart--palpitations--is a common complaint that can occur under normal or abnormal circumstances. For example, normal palpitations occur with exercise, emotions, and stress, or after taking substances that increase adrenergic tone or diminish vagal activity (coffee, nicotine, and adrenergic or anticholinergic drugs). Normal palpitations are recognised as such because individuals who experience them realise or are told that something happened to accelerate the normal rhythm of the heart. However, some people find sinus tachycardia troublesome enough to seek medical attention. In other situations palpitations are clearly abnormal. The heart beat which is felt for no apparent reason, may be fast, or strong and slow, or feel like a missed or extra beat. Although these abnormal palpitations usually point to a cardiac arrhythmia, this is not always the case. Moreover, many patients with arrhythmias do not have palpitations but manifestations such as syncope, shock, and chest pain (sudden death is also possible). We will discuss the approach to the patient who seeks medical attention because of a history of palpitations, with special emphasis on the history, physical examination, and 12-lead electrocardiogram (ECG) because they are simple and inexpensive diagnostic tools that are available to most physicians.
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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 [7]
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 [7]
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 [7]
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- Authors
- Brugada, P., Andries, E., Gürsoy, S., & Brugada, J.
- Affiliations
- Onze Lieve Vrouwziekenhuis Hospital (BE)
- Corresponding author
- Brugada, Pedro
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1993-05
- Volume
- 341
- Issue
- 8855
- Pages
- 1254-1258
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2000151432
- Cited by
- 71
- References
- 17
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 6 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (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 › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- palpitations, cardiac arrhythmias, sinus tachycardia, 12-lead ECG, clinical history taking, physical examination, adrenergic stimulation, parasympathetic activity, syncope, sudden cardiac death, chest pain
- MeSH terms
- Arrhythmias, Cardiac, Electrocardiography, Humans, Medical History Taking, Physical Examination, Tachycardia, Catheter Ablation
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