Palpitations: what they are, what are the symptoms and what pathologies they can indicate

By Cristiano Antonino Last updated Feb 10, 2023

Heart palpitations occur in various conditions: when the normal and regular heartbeat increases in frequency to the point of perceiving an accelerated and very fast beat in the chest, throat or neck, when due to an irregularity of the heartbeat compared at normal rhythm, sensations such as thuds, pauses, sudden and brief accelerations of the heart or constantly irregular heartbeat are felt

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What are the symptoms of palpitations?

Frequent palpitations can be frightening for those affected, but many times they are simply due to stress and bad habits and are therefore not particularly dangerous.

However, other times they are a sign of heart disease or another bodily disorder.

For this reason, when palpitations are frequent or when they are associated with other symptoms such as chest pain, dizziness, fainting, it is advisable to consult a cardiologist.

In the event of benign symptoms, often the only advice on changing lifestyle and the reassurances given by a cardiologist solve the problem.

Other times, however, the cardiologist identifies, starting from the symptoms such as heart palpitations and palpitations, other underlying pathologies (cardiac or hormonal or of other kinds) as they arise, thus predicting important complications for your health.

Accurate analysis of symptoms is important to guide the diagnosis.

Among the most important features:

the duration (seconds, minutes, hours),
the type of onset and resolution (sudden or gradual),
the situations in which symptoms occur more frequently (under effort, after effort, at rest, etc.),
the sensation reported by the patient (“dive”, “flutter”, “throat lump”, “hit in the chest”, “missing beat”, sudden acceleration, “drum roll”),
symptoms associated with palpitations (chest pain, sweating, syncope, etc).

For the correct diagnostic classification of palpitations, in addition to the medical history and clinical visit, the tests carried out in the first instance are:

the electrocardiogram (particularly useful if acquired in the presence of symptoms),
cardiac Holter,
the echocardiogram,
some blood chemistry and hormone tests.

In other cases, further tests are necessary to make the diagnosis, such as the stress test, the 12-lead Holter, the external or implantable (subcutaneous) loop recorder.

Finally, in some cases, an endocavitary electrophysiological study must be carried out to make the diagnosis with certainty.

This minimally invasive examination consists in the introduction of some tubes through the femoral vein (the right or left groin), if necessary, through the subclavian vein (under the collarbone) or jugular (the neck).

After introducing them into the vessels, the catheters are pushed to the heart under the guidance of x-rays and positioned in some specific areas of the heart.

Through these catheters it is possible to record the electrical signals coming from the various areas of the heart, to stimulate the heart through artificial electrical impulses and to induce/reproduce arrhythmias responsible for the disturbances that the patient feels.

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At the end, according to the results of the study, several conditions can occur:

the electrophysiological study does not show any arrhythmia, it is therefore possible that the symptoms are not due to disturbances in the electrical system of the heart;
the arrhythmia can be eliminated by radiofrequency transcatheter ablation, which is performed in the same session;
your arrhythmia cannot be eliminated either by ablation, in which case drug therapy will be prescribed.

Not infrequently, it is the finding of absence of rhythm or heart rate disturbances despite the reported palpitations.

They are generally subjects exposed to stress or suffering from anxiety disorders that feel even the normal heartbeat in a conscious and annoying way.

Equally not infrequent is the finding of sinus tachycardia, sometimes secondary to other conditions, sometimes not associated with anything else (inappropriate sinus tachycardia).

In a fair percentage of cases palpitations are instead the symptom of an arrhythmia associated or not with a structural heart disease.

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What are the most common causes of palpitations?

Here are the most common causes of palpitation and abnormal heartbeat:

Stress. In most cases, a normal but excessively fast heart rhythm (sinus tachycardia) arises in response to an emotional stimulus such as, for example, work stress, anxiety or even worse, a panic attack.
Physical effort. Exercising, especially in sedentary people, can cause palpitations if the heart rate increases to the level of strenuous physical exertion (such as when climbing stairs or shoveling snow).
Too much caffeine. Excessive consumption of stimulants such as caffeine and theine found in coffee, tea or sodas and energy drinks can increase the heart rate and cause palpitations.
Stimulants. Nicotine from cigarettes and stimulants in alcohol, diet pills, and drugs (such as cocaine or amphetamines) cause an increased heart rate and/or heart rhythm disturbances and can cause palpitations.
Hormonal changes. Hormonal swings associated with menopause, menstruation and pregnancy can cause the heart rate to skyrocket and cause the heart to flutter.
Medicines. Often cough and cold medications and asthma inhalers contain stimulant ingredients such as pseudoephedrine and beta agonists that can cause the heart rate to increase or arrhythmias and cause palpitations.
Hyperthyroidism. Palpitations can also arise as a result of a health problem. For example, a fast heart rate can be a warning sign of hyperthyroidism (overactivity of the thyroid gland).
Arrhythmias. In the case of arrhythmias (heart beat alterations or irregular heart rhythm) the heart occasionally skips a beat (extrasystole) or beats with a rhythm other than the physiological one (tachyarrhythmia, the most common are atrial fibrillation and paroxysmal supraventricular tachycardias) or beats in a normal rhythm but faster than normal in the absence of other disorders (inappropriate sinus tachycardia).
Heart problems. Palpitations are often indicative of more serious heart problems, such as congestive heart failure, heart valve or muscle dysfunction, coronary artery disease.