Rapid Heartbeat (Palpitations): Common Causes and When to Seek Care

Palpitations (awareness of heartbeat) are common. Most are benign; some signal arrhythmia or systemic illness.

Common Triggers

• Adrenergic: Anxiety, stress, panic, exercise, caffeine, nicotine, stimulants (amphetamines, cocaine).
• Metabolic: Hypoglycemia, hyperthyroidism, anemia, electrolyte imbalance (K⁺, Mg²⁺, Ca²⁺), dehydration/fever.
• Cardiac: PVCs, PACs, AFib, SVT, VT. Structural heart disease increases risk.
• Medications: Beta-agonists (albuterol), thyroid hormone, decongestants, anticholinergics, digoxin toxicity.
• Hormonal: Pregnancy, menopause, pheochromocytoma (rare).

Red Flags (Seek Immediate Care)

• Syncope, near-syncope, chest pain, dyspnea.
• Palpitations at rest >120 bpm or irregularly irregular (suggests AFib).
• History of heart disease, cardiomyopathy, channelopathy.
• Family history of sudden cardiac death.

Evaluation

• ECG, Holter/event monitor, echocardiogram.
• Labs: TSH, CBC, BMP, Mg, troponin if indicated.
• EP study if recurrent symptomatic arrhythmia.

Management

• Eliminate triggers (caffeine, stimulants).
• Rate/rhythm control (beta-blockers, CCBs, antiarrhythmics).
• Anticoagulation if AFib (CHA₂DS₂-VASc).
• Ablation for refractory SVT/AFib/VT.

Benign ectopy is common; structural heart disease + symptoms = urgent evaluation.