Defined as sensation of heart pounding or fluttering, oftentimes rapidly but not necessarily
………………..Causes
** Anxiety (including Panic Attack) — most common cause
** Heart Arrhythmia (abnormal rhythm)
- Not Serious — Common
- Serious — Uncommon
- See link for explanations
** Medical Conditions (uncommon causes)
- Hyperthyroidism
- Anemia
- Pheochromocytoma
- Low Blood Glucose (only if on insulin or certain oral diabetic medications, see โHypoglycemiaโ under Diabetes)
** Drugs, Medications, lots of caffeine
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………………..Diagnostic Work-Up
History
Palpitations only last seconds: Extra Heart Beats, never serious, very common
Lasting minutes or more: Anxiety; Arrhythmias (usually not serious)
Sense of about to faint (or actual faint) โ Arrhythmias (quite possibly serious)
Only at night, in bed โ Surely Anxiety
Start, & esp. Stop, abruptly โ Arrhythmia (not serious)
Irregular heart rhythm โ Arrhythmia (serious or non-serious)
Heart Rate >160 (if able to count pulse) โ Arrhythmia (serious or not serious)
Occurs with Exercise โ If completely new, may be an Arrhythmia
Hearts normally beat fast with exercise, but shouldnโt be a new occurrence
Goes Away with Exercise โ Anxiety most likely
Certain maneuvers make palpitations with very rapid heart rate go awayย โย Arrhythmia (not serious)
- Bend completely over, looking back between legs; OR
- Prop self with feet up, shoulders down, against a wall
- Other maneuvers: Massage pulse in neck / Strain hard
- What always works: Thrust face into pan of ice water !!!

Family History of unexplained sudden death, or Wolff-Parkinson-White disease โ could be those same diseases
Exam in Clinic
Only useful if symptoms present at time of exam
Electrocardiogram (EKG)
If Symptoms Present at time of test โ EKG will make diagnosis if cause is cardiac
No Symptoms present โ EKG may have clues to likely diagnosis if cardiac cause
Blood Tests: Rarely useful
- TSH for Hyperthyroidism
- CBC for Anemia
- Only test for Pheochromocytoma if severe Hypertension
- Suspect Hypoglycemia if patient on insulin or certain meds for Diabetes
Ambulatory EKG (portable; brief showers OK)
- Done for 1-2 days, or 2-4 weeks (or ongoing — see below)
- Finds heart Arrhythmias (or not) at moment of symptoms
………………..Diagnostic Work-Up
Palpitations only last seconds โ Extra Heart Beats
- This is Normal. No tests or treatment. No worry
Blood Tests are Positive โ Diagnose those conditions (see above)
Arrhythmia found โ See link for the different types
- If palpitations occurred during time of Arrhythmia, thatโs the Diagnosis
- If no palpitations during time of arrhythmia:
- Anxiety likely cause of symptoms (unless serious type of Arrythmia)
No Arrhythmia with up to 2-4 week Ambulatory EKG:
- If palpitations occurred during monitoring โ Anxiety is likely cause
- If no palpitations occurred during monitoring, we consider an ongoing monitor (implanted under the skin). Usually only for patients who:
- Faint (with or without palpitations); or
- Feel like theyโre about to Faint; or
- Palpitations infrequent but disabling (e.g. with shortness of breath / chest pain).
………………..About Anxiety
If palpitations do occur during Ambulatory EKG monitoring, but there are no arrhythmias found at that time, then the cause is like Anxiety. This can be ongoing chronic anxiety, or merely temporary stressors that act subconsciously. Oftentimes nothing is actually identified, and the palpitations go away with time.