Palpitations

Palpitations are the awareness of your own heartbeat. Healthy hearts beat all the time, but you usually don't feel it. When you do, the question is: is the heart actually doing something abnormal, or is the heart fine and you've become more aware of normal beats?

Common causes

• Sinus tachycardia — normal fast heart in response to anxiety, exercise, caffeine, fever, dehydration, anaemia, hyperthyroidism, or low blood sugar.
• Atrial fibrillation — irregularly irregular heart rhythm. Risk rises with age, BP, diabetes, heart disease. Important because it raises stroke risk.
• Supraventricular tachycardia (SVT) — sudden bursts of fast regular heartbeat lasting minutes to hours, often in young adults.
• Ectopic beats — extra single beats. Usually benign, often felt as "missed beats" or a thud.
• Ventricular tachycardia / VPCs — fast ventricular rhythm. Less common, more dangerous, usually in people with known heart disease.
• Hyperthyroidism — palpitations + weight loss + heat intolerance + tremor.
• Anxiety / panic — palpitations with tingling, breathlessness, fear.

How we diagnose

The challenge with palpitations is that they often aren't happening when the patient is in OPD. Tools we use:

• Resting ECG — captures rhythm at the moment.
• Holter monitor — 24-hour or 48-hour continuous ECG that the patient wears home.
• Event recorder — patient pushes a button when palpitations start, captures the rhythm.
• ECHO — to check the heart structure.
• Blood tests — thyroid, electrolytes, sometimes troponin.

Even when the workup is normal, the value of having looked is that we can give a confident "this is benign, no treatment needed" verdict — which often reduces the palpitations themselves (anxiety amplifies awareness).