Evaluation of patients with palpitations
Abstract
Palpitations are one of the most common problems of outpatients who present to internists and cardiologists. Although usually benign, they are occasionally a manifestation of potentially life-threatening conditions. The physician's fear of missing a treatable condition may lead to the inappropriate use of expensive tests with little diagnostic and therapeutic value. The following discussion will describe the common presentations of palpitations and offer a guide to rational diagnostic testing.Common Presentations: Symptoms and Associated CircumstancesSymptomsPalpitations are described in a myriad of ways, but some specific symptoms are common and useful for narrowing the differential diagnosis.Flip-Flopping in the . . .
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In many cases, a definitive or at least probable diagnosis of the cause of palpitations is not reached and no specific therapy is initiated.
“Indeed, in many cases a definitive, or at least probable, diagnosis of the cause of palpitations is not reached and no specific therapy is initiated.5,6”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [5]
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 [5]
Cardiac arrhythmias and psychosomatic disorders are not mutually exclusive.
“It must be borne in mind, however, that cardiac arrhythmias and psychosomatic disorders are not mutually exclusive.5,24”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [5]
Patients are not always able to describe the characteristics of their symptoms precisely; it may therefore be difficult to identify the type of palpitation accurately, especially in the case of normal-rate palpitations.
“It should, however, be stressed that patients are not always able to describe the characteristics of their symptoms precisely.It may therefore be difficult to identify the type of palpitation accurately, especially in the case of normalrate palpitations.5,9,61”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [5]
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 [5]
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 [5]
A substantial percentage (6-35%) of arrhythmias diagnosed in patients with palpitations of unknown origin who undergo ambulatory ECG monitoring are clinically significant, such as supraventricular tachycardias and atrial fibrillation.
“a substantial percentage (6-35%) of the arrhythmias diagnosed prove to be clinically significant, such as supraventricular tachycardias and atrial fibrillation.5”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [5]
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- Authors
- Zimetbaum, P., & Josephson, M. E.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- ORCID
- Zimetbaum, Peter
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1998-05-07
- Volume
- 338
- Issue
- 19
- Pages
- 1369-1373
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2007450066
- Cited by
- 172
- References
- 23
- Citations by year
- 2026: 8 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 8 · 2019: 8 · 2018: 7 · 2017: 11 · 2016: 8 · 2015: 10 · 2014: 7 · 2013: 7 · 2012: 7
- FWCI
- 3.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (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, differential diagnosis, diagnostic testing, unnecessary testing, cardiac arrhythmias, presenting symptoms
- MeSH terms
- Anxiety Disorders, Arrhythmias, Cardiac, Catecholamines, Electrocardiography, Humans, Posture, Exercise, Electrocardiography, Ambulatory, Panic Disorder
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