How do I know if heart palpitations are caused by an irregular heart rhythm?

Doctor's Answers (1)

My general approach to palpitations involves a detailed history and examination, followed by investigations tailored to each patient’s clinical presentation. As there are many causes of palpitations, a detailed assessment is needed to distinguish the various causes. 

When looking out for irregular heart rhythms (arrhythmia) in particular, I pay attention to the heart rate (too slow or too fast?), blood pressure (too low or too high?), pulse (regular or irregular?). I will also auscultate the heart to check for abnormal heart sounds like murmurs. Additionally, a quick and simple test I tend to do is an ECG. This allows me to check the heart rate, rhythm, and any other abnormalities. Bear in mind that an ECG is only a snapshot of the electrical activity in your heart and a normal ECG might not fully exclude arrhythmia. Further tests may be ordered depending on each patient’s case. 

You might be surprised that not all palpitations are caused by heart conditions!

Common causes of palpitations include:

  • Caffeine

  • Nicotine

  • Certain medications - eg. pseudoephedrine

  • Illegal drugs - eg. cocaine

  • Stress/anxiety/panic attack

  • Fever

  • Thyroid issues

  • Anaemia

  • Low blood pressure

  • Heart conditions - eg. arrhythmia, heart attack, valvular abnormalities

Investigations for palpitations may include:

  • Blood tests - eg. full blood count, thyroid function tests, electrolytes

  • ECG 

  • Holter (continuous ECG monitoring) 

  • Echocardiogram 

Please consult your doctor if you are experiencing palpitations! Some cases can be life-threatening!

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All content posted is for general informational purposes only and is not a substitute for professional medical advice. This Q&A is not a patient consultation and any information provided herein is not intended to replace consultation with a qualified medical professional. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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