{"id":2471,"date":"2025-12-03T21:20:16","date_gmt":"2025-12-04T03:20:16","guid":{"rendered":"https:\/\/drakarlacastolo.com\/?p=2471"},"modified":"2025-12-03T21:22:23","modified_gmt":"2025-12-04T03:22:23","slug":"palpitations-common-causes-and-when-to-worry","status":"publish","type":"post","link":"https:\/\/drakarlacastolo.com\/en\/blog\/diagnostic-evaluation\/palpitations-common-causes-and-when-to-worry\/","title":{"rendered":"Palpitations: common causes and when to worry about them"},"content":{"rendered":"<p>\u201cMy heart is racing,\u201d \u201cI feel pounding in my chest,\u201d \u201cIt feels like my heart is going to burst out.\u201d The <strong>palpitations<\/strong> are one of the most frequent reasons for cardiology consultations and also one of the most anxiety-producing sensations.<\/p>\n\n\n\n<p>In this guide you will see:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>What palpitations can mean.<\/li>\n\n\n\n<li>Frequent causes, cardiac and non-cardiac.<\/li>\n\n\n\n<li>What studies help to clarify the diagnosis.<\/li>\n\n\n\n<li>When it is reasonable to observe and when it is appropriate to go to a cardiologist or to the emergency room.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">What exactly are palpitations<\/h2>\n\n\n\n<p>We call \u201cpalpitations\u201d the <strong>conscious perception of the heartbeat<\/strong>. Some people describe them as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Very fast heartbeat.<\/li>\n\n\n\n<li>Strong blows or \u201chammer blows\u201d to the chest.<\/li>\n\n\n\n<li>Irregular heartbeat, as if the heart \u201cjogged\u201d or \u201cskipped a beat\u201d.<\/li>\n\n\n\n<li>Fluttering sensation in the chest or neck.<\/li>\n<\/ul>\n\n\n\n<p>Key points:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Not all palpitations mean a serious arrhythmia.<\/li>\n\n\n\n<li>Nor is everything \u201cjust nerves\u201d: the clinical context and the studies are what define its importance.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Common causes of palpitations<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Extrasystoles (advanced beats)<\/h3>\n\n\n\n<p>They are beats that are ahead of the normal rhythm and are often followed by a short pause. They feel like:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u201cA heavy blow\u201d to the chest.<\/li>\n\n\n\n<li>\u201cIt stopped me for a moment and then hit really hard.\u201d.<\/li>\n<\/ul>\n\n\n\n<p>In people with structurally healthy hearts, they are usually <strong>benign<\/strong>, although very annoying. Even so, they should be documented:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>With a <a href=\"https:\/\/drakarlacastolo.com\/en\/studies\/electrocardiogram-echocardiogram\/\" data-type=\"page\" data-id=\"2060\">electrocardiogram (ECG)<\/a> if they appear during the consultation.<\/li>\n\n\n\n<li>With a <a href=\"https:\/\/drakarlacastolo.com\/en\/studies\/24h-holter-echocardiography\/\" data-type=\"page\" data-id=\"2071\">Holter ECG of <\/a><a>24 hours<\/a> if they are intermittent.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Supraventricular tachycardias<\/h3>\n\n\n\n<p>These are fast-paced episodes that begin and end abruptly:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suddenly the heart races very fast, sometimes with tightness or discomfort.<\/li>\n\n\n\n<li>The episode may last seconds or minutes.<\/li>\n<\/ul>\n\n\n\n<p>Many are treatable with maneuvers, drugs or, in selected cases, electrophysiological studies. To document them, the Holter or, if they are very sporadic, other event monitors are usually key.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Atrial fibrillation<\/h3>\n\n\n\n<p>It is a very common arrhythmia, especially in people with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hypertension, obesity or sleep apnea.<\/li>\n\n\n\n<li>Structural heart disease.<\/li>\n\n\n\n<li>Advanced age.<\/li>\n<\/ul>\n\n\n\n<p>It is characterized by a rhythm:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Irregular<\/strong>, sometimes fast, sometimes not so fast.<\/li>\n\n\n\n<li>It may be accompanied by fatigue, shortness of breath or intolerance to exertion.<\/li>\n<\/ul>\n\n\n\n<p>It is important to detect it because it is associated with increased risk of <strong>brain event<\/strong>. The ECG and Holter are essential to diagnose it.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Non-cardiac causes<\/h3>\n\n\n\n<p>It's not all heart problems. They can also cause palpitations:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Anxiety, panic attacks, intense stress.<\/strong><\/li>\n\n\n\n<li>Caffeine, energy drinks, alcohol, nicotine, some recreational drugs.<\/li>\n\n\n\n<li>Fever, anemia, thyroid disorders.<\/li>\n\n\n\n<li>Dehydration or intense physical effort without preparation.<\/li>\n<\/ul>\n\n\n\n<p>The fact that anxiety plays a role does not mean that \u201ceverything is psychological\u201d; the prudent thing to do is to first rule out relevant cardiac causes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Studies that help to clarify palpitations<\/h2>\n\n\n\n<p>Depending on your medical history and symptoms, your cardiologist may indicate:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Electrocardiogram (ECG)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>It is a basic and quick study.<\/li>\n\n\n\n<li>Useful if palpitations are present at the time of the study or if there are baseline changes in rhythm.<\/li>\n\n\n\n<li>You can learn more on the <a href=\"https:\/\/drakarlacastolo.com\/en\/studies\/electrocardiogram-echocardiogram\/\" data-type=\"page\" data-id=\"2060\">electrocardiogram <\/a><a>(ECG)<\/a>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">24-hour Holter ECG<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Record your heart for a full day (or more, depending on the protocol).<\/li>\n\n\n\n<li>Ideal when palpitations occur intermittently and are not captured in the office.<\/li>\n\n\n\n<li>More details in <a href=\"https:\/\/drakarlacastolo.com\/en\/studies\/24h-holter-echocardiography\/\" data-type=\"page\" data-id=\"2071\">24-hour Holter ECG (Electrocardiogram)<\/a><a>outpatient program)<\/a>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Cardiac check-up<\/h3>\n\n\n\n<p>When, in addition to palpitations, there are risk factors (hypertension, diabetes, high cholesterol, family history), a more complete assessment is recommended:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Detailed medical history.<\/li>\n\n\n\n<li>Physical examination and blood pressure.<\/li>\n\n\n\n<li>ECG and, as appropriate, echocardiogram, laboratory studies and stress tests.<\/li>\n<\/ul>\n\n\n\n<p>This is integrated within a <a>c<\/a><a href=\"https:\/\/drakarlacastolo.com\/en\/cardiac-checkup\/\" data-type=\"page\" data-id=\"2027\">heck-up cardiologi<\/a><a>co<\/a>.<\/p>\n\n\n\n<p>In many cases, the key is to correlate <strong>what you feel<\/strong> with <strong>what you see in the trace<\/strong>If at the time of palpitation the ECG shows a significant arrhythmia, the management will be different from when the rhythm is completely normal.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When to observe and when to consult an outpatient<\/h2>\n\n\n\n<p>May be reasonable <strong>observe and record<\/strong> (without immediate alarm) when:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The palpitations are brief, sporadic and clearly related to coffee, lack of sleep, acute stress or occasional exertion.<\/li>\n\n\n\n<li>They are not accompanied by chest pain, shortness of breath or dizziness.<\/li>\n\n\n\n<li>You have no known history of heart disease.<\/li>\n<\/ul>\n\n\n\n<p>Even so, if they become frequent or worrisome, a scheduled office evaluation is a good idea.<\/p>\n\n\n\n<p>It is convenient <strong>consult your cardiologist<\/strong> in the coming weeks, yes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The palpitations are recurrent, last several minutes or force you to stop activities.<\/li>\n\n\n\n<li>They are accompanied by a feeling of \u201cemptiness in the chest\u201d, slight dizziness or unusual fatigue.<\/li>\n\n\n\n<li>You have hypertension, diabetes, high cholesterol, thyroid disease or a family history of arrhythmias or sudden death.<\/li>\n<\/ul>\n\n\n\n<p>In these cases, you can schedule a <a href=\"https:\/\/drakarlacastolo.com\/en\/cardiac-checkup\/\" data-type=\"page\" data-id=\"2027\">cardio check-up<\/a><a>logical<\/a> to integrate symptoms, risk factors and studies.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When to go to the emergency room<\/h2>\n\n\n\n<p>You should seek immediate attention if palpitations are accompanied by:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Intense chest pain or tightness.<\/li>\n\n\n\n<li>Significant shortness of breath or choking sensation.<\/li>\n\n\n\n<li>Fainting or loss of consciousness.<\/li>\n\n\n\n<li>Marked weakness on one side of the body, slurred speech or sudden visual loss.<\/li>\n\n\n\n<li>Very rapid and sustained palpitations with intense dizziness, cold sweats or a feeling of faintness.<\/li>\n<\/ul>\n\n\n\n<p>In these scenarios, the priority is the <strong>urgent assessment<\/strong> and record the rhythm at that time.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What a good plan looks like in the face of palpitations<\/h2>\n\n\n\n<p>In practice, proper management usually includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Detailed clinical history (when they started, what they are associated with, history).<\/li>\n\n\n\n<li>Baseline ECG and, if necessary, <strong>24 h Holter<\/strong> or other types of monitoring.<\/li>\n\n\n\n<li>Evaluation of risk factors and associated diseases (thyroid, anemia, anxiety, stimulant use).<\/li>\n\n\n\n<li>Clear plan:\n<ul class=\"wp-block-list\">\n<li>Reassure when the findings are benign.<\/li>\n\n\n\n<li>Treat arrhythmias that require it.<\/li>\n\n\n\n<li>Define whether periodic cardiology follow-up is needed.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>If palpitations have become a constant concern or are already limiting your activities, you can use the form of <a href=\"https:\/\/drakarlacastolo.com\/en\/contact\/\" data-type=\"page\" data-id=\"215\">contact<\/a> to schedule an assessment and define, with objective data, what is going on with your heart.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Al-Khatib S.M. et al. 2017 AHA\/ACC\/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.<br><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000549\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000549<\/a><\/li>\n\n\n\n<li>Page R.L. et al. 2015 ACC\/AHA\/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia.<br><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000311\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000311<\/a><\/li>\n\n\n\n<li>January C.T. et al. 2019 AHA\/ACC\/HRS Guideline for the Management of Patients With Atrial Fibrillation.<br><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000665\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000665<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u201cSe me acelera el coraz\u00f3n\u201d, \u201csiento golpes en el pecho\u201d, \u201cparece que se me va a salir el coraz\u00f3n\u201d. Las palpitaciones son uno de los motivos de consulta cardiol\u00f3gica m\u00e1s frecuentes y tambi\u00e9n una de las sensaciones que m\u00e1s ansiedad generan. En esta gu\u00eda ver\u00e1s: Qu\u00e9 son exactamente las palpitaciones Llamamos \u201cpalpitaciones\u201d a la percepci\u00f3n [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2473,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2471","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-evaluacion-diagnostico"],"acf":[],"_links":{"self":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts\/2471","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/comments?post=2471"}],"version-history":[{"count":0,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts\/2471\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/media\/2473"}],"wp:attachment":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/media?parent=2471"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/categories?post=2471"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/tags?post=2471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}