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Heart Palpitations: the cause may be elusive

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The August issue of Mayo Clinic Health Letter discussed various types of heart sensations or palpitations, which are the most common reason people seek medical care for heart issues. In most cases, palpitations don’t signal a larger problem. But sometimes they do, and medical professionals can help you sort out the cause and severity.

An episode of palpitations often does not occur during your doctor appointment. Instead, potential causes may emerge from a thorough health history, physical exam and description you provide of your palpitations as well as any other symptoms that may occur along with them. Your doctor may ask you to tap out with your finger what the palpitations feel like. Often the cause of your heart palpitations can’t be found. Common causes include:

  • Strong emotional responses, such as stress, anxiety or panic attacks
  • Depression
  • Strenuous exercise or exertion
  • Alcohol consumption and withdrawal
  • Stimulants, including caffeine, nicotine, cocaine, amphetamines, cold and cough medications that contain pseudoephedrine, and some inhaled asthma medications
  • Fever
  • Hormone changes associated with menstruation, pregnancy or menopause
  • Too much or too little thyroid hormone

Treatment depends on cause

Initial tests often include blood work to screen for underlying conditions and an electrocardiogram (ECG), which measures the electrical activity of your heart. The ECG may not capture a palpitation episode, but it may be of value in identifying heart problems such as an underlying tendency to have bouts of irregular heartbeats (arrhythmias) that you can’t feel.

To record your heart’s activity, you may be asked to wear a portable ECG device — called a Holter monitor — for a day or more, even up to a month, as you go about your regular activities. If your palpitations are more sporadic, an event recorder placed under the skin can be used over several weeks and can be self-activated when you feel symptoms. The recorder also can be rewound to display key markers of your heart’s rhythm in the seconds and minutes leading up to the palpitations. Other tests, such as a chest X-ray or echocardiogram, may be done to view the size, structure and function of your heart chambers and valves.

Palpitations may be harmless; other than reassurance, no treatment may be necessary. However, they also may be a clue to other, more dangerous arrhythmias. Check back with your doctor if palpitations become more frequent, noticeable or bothersome. Drugs or procedures to treat these abnormal heart rhythms may be required. If palpitations stem from an underlying condition — such as an overactive thyroid gland (hyperthyroidism) — treating that condition may take care of the associated palpitations.

This is expanded content from the August, 2021 Mayo Clinic Health Letter article titled “Heart Palpitations.”

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