Palpitations

A frequent medical office visit is for the complaint of one’s heart beating hard, fast and/or skipping beats.  This is known as palpitations, and is a very common problem with multiple causes, some of which are serious.  Generally, the reasons for this problem falls into one of three categories:

1. Cardiac Causes:  This typically includes either a structural problem such as a leaky or tight valve, blocked artery or enlarged heart (see chest xray above), or an electrical circuit abnormality.  Many times these causes occur together.
2. Medical Condition Causes: This includes medical conditions such as panic and anxiety disorders, thyroid disease, and anemia. Simply being stressed or having a fever can also induce symptoms.
3. Medicinal/Substance Causes: The list is long and includes various prescription, over-the counter and herbal remedies, and legal and illegal drugs.  Prescription medications commonly implicated include inhalers for asthma (albuterol) and stimulants for weight loss (phenteramine).  Additionally, decongestants (Sudafed) and ephedra-type products and thyroid supplements containing iodine can cause the problem.  Caffeine, alcohol and tobacco can precipitate palpitations, as can cocaine and methamphetamine use.

Generally, the cause is more serious when the palpitations are accompanied by chest pressure, lightheadedness or loss of consciousness, shortness of breath, drop in blood pressure or high fever.  All new palpitations should be evaluated by a physician.  Evaluation typically includes labwork, an EKG and, if felt necessary based on symptoms and examination, a heart rhythm test (Holter monitor), ultrasound of the heart (echocardiogram) and exercise treadmill test.