My general approach to palpitations involves a detailed history and examination, followed by investigations tailored to each patient’s clinical presentation. As there are many causes of palpitations, a detailed assessment is needed to distinguish the various causes.
When looking out for irregular heart rhythms (arrhythmia) in particular, I pay attention to the heart rate (too slow or too fast?), blood pressure (too low or too high?), pulse (regular or irregular?). I will also auscultate the heart to check for abnormal heart sounds like murmurs. Additionally, a quick and simple test I tend to do is an ECG. This allows me to check the heart rate, rhythm, and any other abnormalities. Bear in mind that an ECG is only a snapshot of the electrical activity in your heart and a normal ECG might not fully exclude arrhythmia. Further tests may be ordered depending on each patient’s case.
You might be surprised that not all palpitations are caused by heart conditions!
Common causes of palpitations include:
Caffeine
Nicotine
Certain medications - eg. pseudoephedrine
Illegal drugs - eg. cocaine
Stress/anxiety/panic attack
Fever
Thyroid issues
Anaemia
Low blood pressure
Heart conditions - eg. arrhythmia, heart attack, valvular abnormalities
Investigations for palpitations may include:
Blood tests - eg. full blood count, thyroid function tests, electrolytes
ECG
Holter (continuous ECG monitoring)
Echocardiogram
Please consult your doctor if you are experiencing palpitations! Some cases can be life-threatening!
