palpitations

Palpitations are a subjective sensation of the heartbeat, often described as a fluttering, racing, pounding, or skipping beat. They may be felt in the chest, throat, or neck and can occur at rest or with activity. Palpitations are common in healthy people and are frequently related to benign triggers such as caffeine, nicotine, alcohol, anxiety, fever, dehydration, or hormonal changes. They can also arise from cardiac rhythm disturbances or other medical conditions, and their significance depends on accompanying symptoms and risk factors.

Causes of palpitations range from benign to serious. Common noncardiac factors include stimulants, anxiety, stress, fever, anemia, dehydration, electrolyte disturbances, and thyroid disorders. Cardiac causes include premature contractions (atrial or ventricular), atrial fibrillation or other tachyarrhythmias, and less often structural heart disease or heart failure. Rarely, palpitations reflect an acute coronary syndrome or other emergent condition.

Evaluation typically begins with a focused history and physical examination. Red flags requiring urgent care include chest pain, fainting, shortness of breath, fainting spells, or palpitations in people with known heart disease. Diagnostic tests may include a resting ECG, ambulatory rhythm monitoring (Holter or event monitor), echocardiography if structural disease is suspected, and laboratory tests such as thyroid function, complete blood count, and electrolytes.

Management depends on cause and symptoms. Benign palpitations may be addressed with reassurance and avoidance of triggers (caffeine, alcohol, certain medications). If a treatable arrhythmia is identified, appropriate therapy (medication, lifestyle changes, or ablation) may be indicated. In some cases, beta-blockers or other antiarrhythmic therapies are used for symptom control. Regular follow-up is advised if symptoms persist or worsen.