Palpitations: When Should You Be Concerned?

Dr. Ahmed Sallam

Consultant Cardiologist & Cardiac Electrophysiologist

Originally published in Arabic in Al Khaleej Medical Magazine – March 2023.

Introduction

Palpitations refer to the sensation of feeling one’s heartbeat. They may be described as rapid, irregular, pounding, or forceful heartbeats. While many cases are harmless and transient, some may indicate an underlying cardiac condition that requires evaluation.

Understanding when palpitations are benign and when they require medical attention is essential for proper reassurance and timely intervention.

What Are Palpitations?

Palpitations are the subjective awareness of the heartbeat. A person may feel that the heart is racing, skipping beats, fluttering, or beating more forcefully than usual.

They may occur at rest or during physical activity and can last for seconds, minutes, or occasionally longer. In many cases, palpitations are not related to structural heart disease.

Common Causes of Palpitations

Palpitations can result from various factors, including:

• Anxiety and emotional stress

• Physical exertion

• Fever

• Caffeine or stimulant intake

• Certain medications

• Thyroid disorders

• Anemia

• Hormonal changes

In some cases, palpitations may be caused by cardiac rhythm disturbances such as premature beats, supraventricular tachycardia, or atrial fibrillation.

When Should You Be Concerned?

Medical evaluation is recommended if palpitations are accompanied by:

• Chest pain or pressure

• Shortness of breath

• Dizziness or fainting

• Persistent rapid heart rate

• Known structural heart disease

Palpitations that are recurrent, prolonged, or associated with significant symptoms should not be ignored.

How Are Palpitations Evaluated?

Assessment typically begins with a detailed medical history and physical examination.

Diagnostic investigations may include:

• Electrocardiogram (ECG)

• Holter monitoring or event recording

• Echocardiography

• Blood tests (including thyroid function and hemoglobin levels)

These tests help determine whether the cause is benign or requires further management.

Treatment and Management

Management depends on the underlying cause. In many cases, lifestyle modification such as reducing caffeine intake, managing stress, and improving sleep habits may be sufficient.

If a specific arrhythmia is identified, treatment may include medications, catheter ablation, or other targeted therapies depending on the diagnosis.

Conclusion

Palpitations are common and often harmless. However, certain warning signs should prompt medical evaluation to exclude significant cardiac conditions.

Early assessment provides reassurance in benign cases and ensures appropriate treatment when necessary.