Palpitations are a relatively common sensation that many individuals have experienced at some point in their lives. They are defined as an awareness of one's often abnormal heartbeat and can range from a brief flutter to a sustained, racing-heart sensation. It is important to understand the underlying cause(s) and seek medical attention if necessary.

What causes palpitations?

The causes of palpitations can vary widely, and they can be classified into two broad categories: cardiac and non-cardiac.

Cardiac causes include arrhythmias, such as atrial fibrillation, supraventricular tachycardia and ventricular tachycardia — more on that below. Non-cardiac causes include anxiety, stress, caffeine, nicotine, medications and underlying medical conditions such as anaemia, hyperthyroidism and electrolyte imbalances.

1, Arrhythmias are the most common cardiac cause of palpitations. They occur when the normal electrical impulses in the heart are disrupted, leading to an irregular heartbeat.

· Atrial fibrillation is a common arrhythmia that can cause palpitations. It occurs when the upper cardiac chambers contract rapidly and irregularly, leading to a fast and chaotic heart rate.

· Supraventricular tachycardia (SVT) is another arrhythmia that can cause palpitations. It occurs when the electrical impulses in the atria, albeit regular, start or propagate in an abnormal and fast manner.

· Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that occurs when the lower cardiac chambers or ventricles contract rapidly and/or irregularly.

· Isolated extra heart beats, whether from the upper or the lower chambers of the heart, can also cause instantaneous but repetitive palpitations. In that group, this is the most common, and least concerning cause of palpitations.

2, Anxiety and stress are the most common non-cardiac causes of palpitations. They can cause the release of stress hormones, such as adrenalin, which can increase heart rate and blood pressure.

3, Caffeine, alcohol and nicotine are also common causes of palpitations. They can stimulate the heart, leading to a rapid heartbeat.

4, Certain medications, such as asthma inhalers, decongestants and some antidepressants, can also cause palpitations.

5, Medical conditions such as anaemia, overactive thyroid gland, and electrolyte imbalances can all do the same.

How to diagnose the cause of palpitations?

A thorough medical history and physical examination are essential. The physician will ask about symptoms, medical history, family history, and medication use. He/she will also perform a physical examination, including listening to the heart and checking for signs of underlying medical conditions.

Diagnostic tests, such as those below, may be necessary.

1, ECG or electrocardiogram: it measures the heart's electrical activity and can help diagnose arrhythmias, like atrial fibrillation or extra beats.

2, An echocardiogram uses ultrasound to create images of the heart and can help detect structural abnormalities that can lead to arrhythmias.

3, A Holter monitor is a portable device that records the heart's electrical activity for 24 to 48 hours.

4, An event monitor is a portable device that records the heart's electrical activity for up to 30 days.

5, A loop recorder is inserted under the chest skin and can record heart rhythm changes for up to two years.

6, Recently the introduction of commercial portable devices, mainly smart watches that have the capability to record a rhythm strip, has helped uncover arrhythmias, like atrial fibrillation. However, it is worth mentioning that the accuracy of these wearables remains suboptimal and a misdiagnosis is quite common. In addition, many people using this technology are misinformed, thinking that the watch could uncover a “heart attack”. This in fact is very rare, as a full 12-lead ECG is needed for this — a smart watch records one lead only — and the watch algorithm does not screen for that. Instead, the main value of this feature is a brief electrical rhythm screening, as discussed above.

7, Blood tests can help detect underlying medical conditions, such as anaemia or thyroid disorders.

How to treat palpitations?

Treatment of palpitations depends on the underlying cause.

1, Identify triggers: keeping track of when palpitations occur and what activities or circumstances were happening before they started can help identify potential triggers.

2, Lifestyle modifications: reducing stress, avoiding alcohol, tobacco and caffeine, getting regular exercise, and maintaining a healthy diet can all help reduce the frequency and severity of palpitations.

3, If a given medication is the cause of palpitations, the physician may recommend adjusting the dosage or switching to a different preparation.

4, If the palpitations are caused by an arrhythmia, the physician may recommend medications to restore a normal heart beat. These may include beta-blockers, calcium channel blockers, or specialised anti-arrhythmic drugs.

5, Procedures: if a significant underlying heart condition is identified, procedures such as cardioversion (shocking the heart with an electrical current), ablation (eliminating the arrhythmia site from within the heart using special tools), or implantation of a pacemaker or a defibrillator may be indicated to cure or control palpitations.