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Diagnostic approach to palpitations
1Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. allana@usc.edu
American Family Physician
|March 4, 2005
Summary
Palpitations, or sensations of irregular heartbeats, can stem from arrhythmias or other conditions. Ambulatory ECG monitoring is key when the cause is unclear, with event monitors often preferred for intermittent symptoms.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Palpitations are commonly linked to cardiac arrhythmias or anxiety.
- Various arrhythmias, including sinus tachycardia and atrial fibrillation, can manifest as palpitations.
- Serious causes are suspected when palpitations accompany dizziness, near-syncope, or syncope.
Purpose of the Study:
- To review the causes and diagnostic approaches for palpitations.
- To highlight the role of ambulatory electrocardiographic (ECG) monitoring in evaluating palpitations.
- To compare the effectiveness of different ambulatory monitoring techniques.
Main Methods:
- Review of literature on palpitations and their etiologies.
- Discussion of diagnostic criteria and clinical associations.
- Comparison of ambulatory ECG monitoring methods: Holter, event recording, and trans-telephonic monitors.
Main Results:
- Causes of palpitations are diverse, including arrhythmias, nonarrhythmic cardiac issues, noncardiac conditions, and medications.
- Up to 16% of patients may have an unidentified cause for palpitations.
- Ambulatory ECG monitoring is indicated when initial evaluation is inconclusive.
Conclusions:
- Continuous closed-loop event recording is recommended for unpredictable palpitations.
- Trans-telephonic event monitors are generally more effective and cost-efficient than Holter monitors.
- Prompt diagnosis and appropriate monitoring are crucial for managing palpitations.