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Palpitations are one of the most common problems of outpatients who present to internists and cardiologists

They are defined as an unpleasant awareness of the forceful, rapid, or irregular beating of the heart. Patients may at times describe the sensation as a rapid fluttering in the chest, flip-flopping in the chest, or a pounding sensation in the chest or neck, and these descriptions may help elucidate the cause of the palpitations

Palpitations are characterized as a general or heightened awareness of your own heartbeat – whether it’s too fast, too slow, or otherwise irregular. You might feel like your heart is thumping, racing, or fluttering. And you could feel this sensation in your chest or your neck.

Palpitations are symptoms of everything from short or long-term stress to a variety of arrhythmias (irregular heartbeats). They may feel alarming, but do not always reflect a serious heart condition

Diagnosing palpitations

Palpitations can occur for a variety of reasons unrelated to heart disease. These include:

  • Overexertion
  • Stress
  • Caffeine, alcohol, tobacco, or diet pills
  • Overactive thyroid
  • Hormone changes associated with menstruation, pregnancy, or menopause
  • Low blood pressure
  • Heart disease or abnormal heart valves
  • The body’s response to medications such as thyroid pills, cold medicines, and asthma drugs

Palpitations can also result from a range of heart arrhythmias. These are classified by location, and type of heartbeat. A few common types:

  • Supraventricular tachycardia – A rapid heart rate originating above the ventricles (lower heart chambers). It can cause the heart to beat very quickly or erratically. Symptoms might include an overly fast pulse and dizziness.
  • Atrial fibrillation – The most common type of arrhythmia, an atrial fibrillation can result in a rapid and erratic heartbeat, which may interfere with blood flow to the ventricles and possibly lead to serious clotting conditions or stroke. Symptoms might not exist at all, or involve chest pain, palpitations, or shortness of breath.
  • Ventricular tachycardia – A rapid heartbeat originating in the ventricles (lower heart chambers). When associated with structural heart disease, this arrhythmia may cause loss of consciousness and, in some cases, cardiac arrest or sudden death.

Separating serious palpitations from harmless ones.Learn about when you should be evaluated for heart palpitations.

It’s important to differentiate palpitations caused by stress or minor arrhythmias from those that may point to an underlying heart disease. Inconveniently, palpitations don’t always occur during the time you’re with your doctor.

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