Palpitations: Evaluation, Management, and Wearable Smart Devices

Palpitations are a common symptom described by patients as a feeling of a racing or fluttering heart, a pounding chest, irregular or skipped heartbeats, or a pounding sensation in the neck. They are associated with a low mortality rate; however, recurrent palpitations have been shown to impair quality of life and increase health care use. Common triggers are cardiac disorders, endocrine and metabolic disorders, medication or illicit drug use, or psychosomatic disorders. A detailed history, physical examination, directed laboratory studies, and 12-lead electrocardiography are often sufficient to identify the etiology of palpitations. Additional testing may be indicated to include echocardiography, cardiac stress testing, electrocardiogram monitoring, or electrophysiologic studies to distinguish whether symptoms correlate with cardiac arrhythmia or structural or ischemic heart disease. Management of palpitations is based on the suspected etiology. In most cases of cardiac-induced palpitations, the treatment can include reassurance, education, trigger avoidance, or use of atrioventricular nodal blockers. Tachyarrhythmias may require cardiac ablation. Patients who have palpitations with no arrhythmia causality and no cardiac disease should be reassured; however, screening for psychosomatic disorders should be considered. Wearable smart devices with ambulatory electrocardiogram monitoring technologies are currently available to consumers; these tools have shown diagnostic accuracy for detection of arrhythmias, allowing patients to have greater participation in their health care. Am Fam Physician. 2024; 110(3):259-269.