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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Palpitations facts
• What are palpitations?
• What is the normal heartbeat?
• What are symptoms of arrhythmias?
• What are the causes of arrhythmias?
• How are palpitations evaluated?
• What is the treatment for palpitations?
• Patient Comments: Palpitations - Effective Treatments
• Patient Comments: Palpitations - Symptoms
• Patient Comments: Palpitations - Causes
• Find a local Cardiologist in your town
• Palpitations Index

Palpitations without associated arrhythmias and heart diseases may not require specific treatment. Patients are often advised simply to reduce emotional and physical stress while monitoring their symptoms.

Palpitations resulting from premature contractions (PACs and PVCs) often require no specific treatment. The frequency of premature contractions can be reduced by stress reduction, quitting smoking, and reducing caffeine, and alcohol consumption. High blood adrenaline levels can lead to premature contractions, while stress reduction helps to lower blood adrenaline levels. For patients with persistent palpitations and premature contractions, medications, such as beta- blockers, can be used to block the effect of adrenaline on the heart, thus reducing premature contractions. Examples of beta-blockers include propranolol (Inderal), metoprolol (Lopressor), and atenolol (Tenormin). Side effects of beta-blockers include worsening of asthma, excessive lowering of heart rate and blood pressure, depression, fatigue, and impotence.

Atrial fibrillation treatments can be complex and involve:

1. reversing the factors that cause atrial fibrillation such as fever, high thyroid hormone levels, and low oxygen levels in blood;
2. slowing the heart rate with calcium channel blockers such as verapamil (Calan), beta-blockers such as propranolol (Inderal), and digoxin (Lanoxin);
3. preventing strokes by using blood thinners such as warfarin (Coumadin) in patients considered to be at high risk of strokes as a result of atrial fibrillation;
4. converting atrial fibrillation to normal heart rhythm with medications such as quinidine (Quinaglute and Quinidex), procainamide (Pronestyl), disopyramide (Norpace), or amiodarone (Cordarone), or electrical shock;
5. preventing recurrence of atrial fibrillation with medications such as amiodarone, catheter ablation procedures such as pulmonary vein isolation, or implantation of pacemakers or defibrillators.

For further information, please read the Atrial Fibrillation article.

The most important causes of ventricular arrhythmias (ventricular tachycardias and fibrillations) are heart attack, inadequate oxygenated blood to the heart muscle (ischemia), and scars from previous heart attacks. Therefore, treatment of coronary heart disease is important in managing patients with ventricular arrhythmias. For patients with persistent ventricular tachycardias, medications such as propanolol (Inderal), sotalol (Betapace), and amiodarone (Cordarone) are used. In patients with life-threatening ventricular fibrillations, implantable defibrillators are considered. Implanted defibrillators can sense the onset of ventricular fibrillation and deliver a jolt of electrical impulse to the heart to convert it back to normal rhythm.

In patients with arrhythmias associated with significant heart muscle or valve disease, correction of the underlying heart disease is important. Patients with severe aortic stenosis can develop heart failure as well as serious ventricular arrhythmias. Treatment of the aortic stenosis by valve repair surgery (valvuloplasty) and/or by surgical valve replacement can alleviate these problems.

Some patients who suffer palpitations also have periods of dizziness or loss of consciousness (syncope). These patients are sometimes evaluated by heart electrical specialists called "electrophysiologists." A more detailed study of the heart's electrical system can be performed by these specialists who use devices to stimulate areas of the heart to detect abnormal electrical pathways.

REFERENCES:

"Heart Palpitations." MedlinePlus. 30 May 2012. <http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm>.

"Heart Palpitations." WebMD Medical Reference. 29 June 2011. <http://www.webmd.com/heart-disease/guide/what-causes-heart-palpitations>.

"Heart Palpitations Overview." FamilyDoctor.org. Sept. 2010. <http://familydoctor.org/familydoctor/en/diseases-conditions/heart-palpitations.html>.