Palpitations

Subjective awareness of rapid, forceful, pounding, fluttering, or irregular heartbeats, often reflecting cardiac arrhythmias, increased cardiac contractility, heightened awareness of normal sinus rhythm, or noncardiac hyperadrenergic states.

Causes

• Emotional causes

  • Stress/anxiety/fear/panic attacks

• Physiological

  • Strenuous physical exercise

  • Pregnancy

• Cardiac causes

  • Sinus tachycardia

  • Premature atrial contractions

  • Premature ventricular contractions

  • Atrial fibrillation

  • Atrial flutter

  • Supraventricular tachycardia

  • Ventricular tachycardia

  • Bradyarrhythmias with compensatory ectopy

  • Valvular heart disease

  • Cardiomyopathy

  • Heart failure

  • Myocarditis

  • Congenital heart disease

• Medication-related causes

  • Pseudoephedrine and other decongestants

  • β₂-agonist asthma inhalers (albuterol/salbutamol)

  • Thyroid hormone replacement

  • Sympathomimetic medications

  • Certain antidepressants

  • Antiarrhythmic medications (proarrhythmic effect)

• Stimulants and recreational substances

  • Caffeine

  • Nicotine

  • Cocaine

  • Amphetamines

  • Alcohol

  • Energy drinks

• Metabolic causes

  • Hyperthyroidism

  • Fever

  • Dehydration

  • Hypoglycemia

  • Anemia

  • Electrolyte disturbances (hypokalemia, hypomagnesemia)

• Other causes

  • Obstructive sleep apnea

  • Postural orthostatic tachycardia syndrome (POTS)

  • Autonomic dysfunction