Palpitations are a common symptom described by patients as a feeling of a racing or fluttering heart, a pounding chest, irregular or skipped heartbeats, or a pounding sensation in the neck. They are associated with a low mortality rate; however, recurrent palpitations have been shown to impair quality of life and increase health care use. Common triggers are cardiac disorders, endocrine and metabolic disorders, medication or illicit drug use, or psychosomatic disorders. A detailed history, physical examination, directed laboratory studies, and 12-lead electrocardiography are often sufficient to identify the etiology of palpitations. Additional testing may be indicated to include echocardiography, cardiac stress testing, electrocardiogram monitoring, or electrophysiologic studies to distinguish whether symptoms correlate with cardiac arrhythmia or structural or ischemic heart disease. Management of palpitations is based on the suspected etiology. In most cases of cardiac-induced palpitations, the treatment can include reassurance, education, trigger avoidance, or use of atrioventricular nodal blockers. Tachyarrhythmias may require cardiac ablation. Patients who have palpitations with no arrhythmia causality and no cardiac disease should be reassured; however, screening for psychosomatic disorders should be considered. Wearable smart devices with ambulatory electrocardiogram monitoring technologies are currently available to consumers; these tools have shown diagnostic accuracy for detection of arrhythmias, allowing patients to have greater participation in their health care.
Am Fam Physician. 2024; 110(3):259–269. Copyright © 2024 American Academy of Family Physicians.
Palpitations account for 16% of outpatient clinic and 0.6% of emergency department visits.1,2 They are one of the most common symptoms prompting referral to cardiology.3 Ten percent of patients during their lifetime will experience palpitations, a subjective awareness of the heart rhythm often described as racing, irregular, fluttering, forceful pounding, skipped beats, or pounding in the neck.4,5 The mechanisms for palpitations are variable and include contraction rates of the heart (i.e., fast, slow, or irregular rhythms), intense contractions and anomalous movement of the heart (e.g., structural heart disease, mitral valve prolapse), and anomalies in the subjective perception of the heartbeat (e.g., minimal cardiac irregularities or normal rhythms felt by the patient during certain situations or positions).6
WHAT'S NEW ON THIS TOPIC
| A systematic review that enrolled participants with arrhythmias demonstrated reductions in palpitation episodes and premature ventricular contractions for patients engaged in a structured yoga practice for 45 to 60 minutes at least 3 days per week. |
| Smartwatches and other consumer-grade devices that record heart rates by photoplethysmography (light-based technology to detect volumetric changes in blood in peripheral circulation) or single-lead electrocardiography can detect arrhythmias, primarily atrial fibrillation. Disadvantages of these devices are their inability to detect asymptomatic arrhythmias and those of short duration; they also have high false-positive detection rates. |
SORT: KEY RECOMMENDATIONS FOR PRACTICE
ECG = electrocardiography.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp. org/afpsort.xml.
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