Palpitations

CLINICAL DIAGNOSTIC MANUAL

Palpitations are the awareness of heartbeats that feel as if the heart is pounding, fluttering, or beating irregularly, often lasting only a few seconds or minutes. They can be alarming when experienced for the first time, though they are usually benign and transient.

However, sometimes they may indicate a more serious underlying condition. Understanding the nature of palpitations and their possible causes is crucial in medicine to differentiate between a minor event and one that requires medical intervention.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Cardiac arrhythmias	Palpitations, syncope, dizziness, shortness of breath. Signs of heart failure may be present.	Medical history and physical examination.	Electrocardiogram (ECG), Holter monitor, electrophysiological study.
Heart diseases	Chest pain, fatigue, dyspnoea, oedema in lower limbs. Signs of cardiac dysfunction may be present.	Clinical evaluation, history of chest pain.	Echocardiogram, cardiac function tests, ECG.
Electrolyte imbalances	Muscle weakness, changes in consciousness level, arrhythmias.	Clinical symptoms, history of kidney disease or diet.	Blood tests for electrolyte levels.
Endocrine disorders	Palpitations, weight loss, heat intolerance in hyperthyroidism; episodic hypertension, palpitations, sweating in pheochromocytoma.	Symptoms and clinical signs, medical history.	Thyroid function tests, dexamethasone suppression test for pheochromocytoma.
Stimulant substance use	Palpitations, nervousness, insomnia, possible agitation or erratic behaviour.	History of substance use.	Medical history, toxicology tests.
Anxiety and panic disorders	Palpitations, sweating, shortness of breath, intense fear or panic.	Clinical evaluation based on symptom presentation.	Psychological assessment and exclusion of medical causes.
Anaemia	Pallor, fatigue, dyspnoea on exertion. Palpitations occur as the body attempts to compensate for low oxygenation.	Clinical signs and symptoms along with medical history.	Complete blood count and other blood tests.