Palpitation Causes

Aka: Palpitation Causes

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II. Causes: By Frequency

  1. Non-organic such as Anxiety Disorder (31%)
  2. Atrial Fibrillation (16%)
  3. Supraventricular Tachycardia (10%)
  4. Medications or recreational drugs (6%)
  5. Systemic disease (4%)
  6. Structural heart disease (3%), esp. Mitral Valve Prolapse
  7. Ventricular Tachycardia (2%)

III. Causes: By Characteristics and Timing

  1. Isolated single beats improved with Exercise
    1. Premature Atrial Contractions
    2. Premature Ventricular Contractions
  2. Slow Heart Rate with Palpitations
    1. Atrioventricular Block
    2. Sinus node disease (e.g. Sick Sinus Syndrome)
  3. Rapid beats with sudden onset (Tachyarrhythmias)
    1. Sinus Tachycardia
    2. Paroxysmal Supraventricular Tachycardia (PSVT)
    3. Paroxysmal Atrial Fibrillation or Atrial Flutter
    4. Ventricular Tachycardia
  4. Intermittent episodes with gradual onset
    1. Caffeine (tea, coffee, soda, Chocolate)
    2. Drugs of Abuse
      1. Cocaine
      2. Methamphetamine and other Amphetamines
      3. Methylenedioxymethamphetamine (MDMA, Ecstasy)
      4. Marijuana
    3. Herbals
      1. Ephedra
      2. Yohimbine
      3. Guarana
      4. Yerba mate
      5. Kola nut
      6. Bitter Orange
      7. Coenzyme Q10
      8. Omega-3 Fatty Acid Supplements
    4. Other medications
      1. Theophylline
      2. Beta Agonists
      3. Digitalis
      4. Performance Enhancing Drugs (e.g. Anabolic Steroids)
    5. Carbon Monoxide toxicity
    6. Tobacco products
    7. Panic Attack
    8. Pheochromocytoma (rare)
    9. Mitral Valve Prolapse
  5. Persistant Palpitations at rest
    1. Anemia (worse with Exercise)
    2. Hyperthyroidism
    3. Hypertension
    4. Beriberi
    5. Fever
    6. Dehydration
    7. Anxiety Disorder
    8. Cardiomyopathy
    9. Pericarditis
    10. Valvular abnormality
      1. Aortic Regurgitation
      2. Mitral Regurgitation
      3. Large Ventricular Septal Defect

IV. Causes: Cardiac

  1. Arrhythmia
    1. Extrasystoles
      1. Atrial premature contractions
      2. Ventricular premature contractions
    2. Supraventricular Tachycardia
      1. Atrial Fibrillation
      2. Atrial Flutter
      3. Atrial Tachycardia
      4. Atrioventricular Nodal Reentry Arrhythmia
      5. Multifocal Atrial Tachycardia
    3. Ventricular Tachycardia
    4. Miscellaneous
      1. Autonomic Dysfunction
      2. Sick Sinus Syndrome
  2. Structural heart disease
    1. General
      1. Structural heart disease patients may experience Palpitations without Arrhythmia
    2. Atrial Myxoma
    3. Cardiomyopathy
    4. Long QT syndrome (Ventricular Tachycardia risk)
    5. Valvular heart disease
    6. Mitral Valve Prolapse

V. Causes: Non-Cardiac

  1. Mood Disorders
    1. Generalized Anxiety Disorder
    2. Panic Disorder (Panic Attacks)
    3. Emotional stress
    4. Somatization Disorder
  2. Medications
    1. See Drugs of Abuse, medications, Herbals as above
    2. Prolonged QT Interval due to Medication
    3. Alcohol
    4. Beta Agonists (e.g. Albuterol)
    5. Beta Blocker withdrawal
    6. Nicotine
    7. Caffeine
    8. Cocaine
    9. Methamphetamine
  3. Miscellaneous
    1. Anemia
    2. Exercise
    3. Fever
    4. Hypoglycemia
    5. Hypovolemia
    6. Mastocytosis
    7. Paget's Disease
    8. Pheochromocytoma
    9. Pregnancy
    10. Thyroid disorders (Hypothyroidism, Hyperthyroidism)
    11. Post-Covid Long-Term Effects

VI. References

  1. Gale (2016) BMJ 352:H5649 [PubMed]
  2. Raviele (2011) Europace 13(7): 920-34 [PubMed]
  3. Wexler (2017) Am Fam Physician 96(12): 784-9 [PubMed]
  4. Wexler (2011) Am Fam Physician 84(1): 63-9 [PubMed]

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