Heart Palpitation

A definition of a heart palpitation describes a person's awareness of the beating heart-–pounding, fluttering–-due to changes in heart rate or rhythm or by increased force of contractions.

Palpitations are usually benign.


  1. Flip-flopping in chest – may be due to atrial premature contractions.

  2. Rapid fluttering in chest - may be due to sinus tachycardia or atrial or ventricular arrhythmias.

  3. Pounding in the neck – may be due to dissociation of atrial and ventricular contractions


  1. Palpitation associated with Anxiety and Panic Reactions – last diagnosis after others ruled out.

  2. Palpitations during Periods of Catecholamine Excess – seen during exercise or during emotionally startling experiences.

  3. Palpitations associated with Position – standing or in bed.

  4. Palpitations associated with Syncope or Near-syncope – can occur with ventricular tachycardias.

Diagnostic Evaluation – need detailed history, physical examination and a 12-lead EKG.

  • Onset in childhood – supraventricular tachycardia like Wolff-Parkinson-White Syndrome (WPW)

  • Rate and degree of regularity of palpitations – rapid and regular suggest supraventricular or ventricular tachycardias and rapid and irregular suggest atrial fibrillation.

  • Mode of onset and termination – if abrupt consider supraventricular or ventricular tachycardias and if patient uses carotid massage or a Valsalva maneuver to terminate palpitations consider supraventricular tachycardias such as WPW

Physical Examination can define potential cardiovascular abnormalities that could be substrates for arrhythmias e.g. mitral valve prolapse has a mid-systolic click – supraventricular and ventricular tachycardias, hypertrophic obstructive cardiomyopathy – atrial fibrillation.

  • 12-Lead EKG can narrow the differential diagnosis of palpitations.

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