Palpitation causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Mugilan Poongkunran M.B.B.S [3] Akash Daswaney, M.B.B.S[4]

Overview

There are a vast number of causes of palpitations, including namely any condition that causes the heart to be rapidly, forcefully, or irregularly. In general, palpitations may be caused by primary abnormalities in the heart (tachycardia or forceful heart beating), reductions in oxygen carrying capacity (anemia), reductions in the volume of blood circulating (dehydration), sympathetic nervous system stiumlation (fever, exertion, panic attacks, drugs), excess hormone production (hyperthyroidism). Pharmacological causes should also be taken into consideration.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Acute coronary syndrome
• Malignant hypertension
• Myocardial infarction
• Third degree AV block
• Ventricular arrhythmia

Common Causes

• Amiodarone
• Anemia
• Atrial fibrillation
• Atropine
• Cardiac glycosides
• Diseases of the valvular structures
• Flurazepam
• Heart block
• Heart failure
• Hypercapnia
• Hypoglycemia
• Hypoxia
• Insulin
• Nitrates
• Panic disorders
• Pregnancy
• Pyrexia
• Supraventricular tachycardia
• Sympathomimetics
• Thyrotoxicosis
• Ventricular tachycardia

Causes by Organ System

Cardiovascular	Acute coronary syndrome, alcoholic cardiomyopathy, Andersen cardiodysrhythmic periodic paralysis, angina, aortic aneurysm, aortic regurgitation, aortic stenosis, arrhythmia, arrhythmogenic right ventricular dysplasia, arteriovenous fistula, atrial fibrillation, atrial flutter, atrial myxoma, atrial septal defect, atrioventricular heart blocks, atypical angina, AV block, AV nodal re-entry tachycardia, bradyarrhythmias, cardiac syndrome X, cardiomegaly, cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia, congenital heart disease, congestive heart failure, cor pulmonale, coronary artery disease, defibrillation, endomyocardial eosinophilic fibrosis, extrasystoles,fosaprepitant, heart attack, heart block, heart failure, hemochromatosis, holiday heart syndrome, hyperkinetic heart syndrome, hypertension, hypertensive cardiomyopathy, hypertrophic cardiomyopathy, hypotension, ischaemic heart disease, Jervell and Lange-Nielsen syndrome, junctional tachycardia, left bundle branch block, long QT syndrome, Lown Ganong Levine syndrome, malignant hypertension, Meprobamate, mitral regurgitation, mitral stenosis, mitral valve prolapse, myocardial contusion, myocardial infarction, myocardial ischemia, myocarditis, NSTEMI, paroxysmal atrial tachycardia, paroxysmal supraventricular tachycardia, patent ductus arteriosus, pericardial tamponade, postpartum cardiomyopathy, premature atrial contractions, premature ventricular contractions, Prinzmetal's angina, prosthetic heart valve, pulmonary embolism, pulmonary hypertension, restrictive cardiomyopathy, rheumatic fever, right bundle branch block, right heart catheterization, right ventricular outflow tract tachycardia, Romano-Ward syndrome, second degree heart block, short QT syndrome, short QT syndrome type 1, short QT syndrome type 2, short QT syndrome type 3, short QT syndrome type 4, short QT syndrome type 5, sick sinus syndrome, sinus tachycardia, STEMI, tachyarrhythmia, Terbutaline, third degree heart block, Timothy syndrome, torsade de pointes, tricuspid insufficiency, unstable angina, valvular heart disease, vasovagal syncope, ventricular aneurysm, ventricular arrhythmia, ventricular septal defect, ventricular tachycardia, Wolff Parkinson White Syndrome
Chemical / poisoning	Arsenic trioxide, arsenicals, betel nut, carbon monoxide, insecticide, scorpion sting, senna
Dermatologic	Dermatomyositis
Drug Side Effect	Alimemazine, almokalant, aminophylline, amiodarone, amitriptyline, amphetamines, anagrelide, antiarrythmics, antidepressants, asenapine, astemizole, atropine, azimilide, azithromycin, bepridil, Benzphetamine, beta blockers, bretylium, budipine, Butorphanol, cardiac glycosides, chloroquine, cibenzoline, cisapride, citalopram, Clemastine, Clomifene, clomipramine, clozapine, cocaine, crizotinib, cyanide, desipramine, Desmopressin, Diethylpropion, digitalis, digoxin, diphenhydramine, disopyramide, disulfiram, dofetilide, dolasetron, doxepin, dronedarone, droperidol, Efavirenz, Epinephrine (aerosol), eribulin mesylate, febuxostat,Felbamate, formoterol, Flavoxate, fluconazole, Flurazepam hydrochloride, gingko biloba, glatiramer acetate, grepafloxacin, halofantrine, haloperidol, hyoscyamine, ibutilide, Isoproterenol (aerosol), imipramine, Imipenem-Cilastatin, indapamide, inotropes, insulin, ketanserin, ketoconazole, Lacosamide, leflunomide, Letrozole, levothyroxine, lidoflazine, lubeluzole, meclofenamate,Megestrol, Metaproterenol, methadone, methadyl acetate, methamphetamine, indomethacin, Metipranolol, midodrine, Milnacipran hydrochloride, mizolastine, moxifloxacin, Nabilone, nabumetone, naltrexone, naratriptan, neuroleptics, Niacin, nicardipine, nicotine, nilotinib, nitrates, Olsalazine, ondansetron, Oprelvekin, orphenadrine, Oxaprozin, Oxcarbazepine, pasireotide, pazopanib, Pentamidine Isethionate, Pergolide, Phendimetrazine, phentermine, phenothiazines, pimozide, piperaquine,Pirbuterol, Polidocanol, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, rizatriptan, ranolazine, repaglinide, Repaglinide and Metformin hydrochloride, retigabine, riociguat, ritodrine, ritonavir, saquinavir, serotonin syndrome, sertindole, sertraline, Siltuximab, sotalol, sparfloxacin, Sulindac, sympathomimetics, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, theophylline, thioridazine, thyroxine, Tiagabine, Trospium, Valdecoxib, vandetanib, vemurafenib, venlafaxine, vernakalant, Vilazodone, voriconazole, vorinostat, ziprasidone, zonisamide, zotepine, zuclopenthixol
Ear Nose Throat	No underlying causes
Endocrine	Aldosteronism, De Quervain's thyroiditis, Graves' disease, Hashimoto's thyroiditis, hyperpituitarism, hyperthyroidism, hypoparathyroidism, hypothyroidism, lymphocytic thyroiditis, multiple endocrine neoplasia type 1, thyroiditis, adrenal tumor
Environmental	Heat exhaustion, heat illness, hypothermia
Gastroenterologic	Dumping syndrome, hemochromatosis
Genetic	Andersen cardiodysrhythmic periodic paralysis, channelopathies, Friedreich's ataxia, glucose-6-phosphate dehydrogenase deficiency, hemochromatosis, Jervell and Lange-Nielsen syndrome, myotonic dystrophy, Romano-Ward syndrome, spherocytosis, Timothy syndrome, Von Hippel-Lindau disease
Hematologic	Anemia, aplastic anemia, glucose-6-phosphate dehydrogenase deficiency, hemochromatosis, hemolytic anemia, iron deficient anemia, megaloblastic anemia, paroxysmal nocturnal hemoglobinuria, pernicious anemia, sickle cell anemia, spherocytosis
Iatrogenic	Cardioversion, electrophysiologic studies, heart surgery , pacemaker, pulmonary artery catheter
Infectious Disease	Chagas disease, fever, hookworm infection, lyme disease, schistosomiasis, typhus
Musculoskeletal / Ortho	Dermatomyositis, myotonic dystrophy, Timothy syndrome
Neurologic	Autonomic neuropathy, Friedreich's ataxia, hyperpituitarism, ganglioneuroma, migraine, pituitary adenoma, vasovagal syncope
Nutritional / Metabolic	Acid-base disturbances, acidosis, acute starvation, electrolyte imbalance, hyperkalemia, hypocalcemia, hypoglycemia, hypokalemia, hypomagnesemia, metabolic acidosis
Obstetric/Gynecologic	Menopause, vaginal bleeding after delivery, vaginal bleeding after hysterectomy
Oncologic	Adrenal tumor, ganglioneuroma, pheochromocytoma, pituitary adenoma, atrial myxoma
Opthalmologic	No underlying causes
Overdose / Toxicity	Alimemazine, almokalant, aminophylline, amiodarone, amitriptyline, amphetamines, anagrelide, antiarrythmics, antidepressants, asenapine, astemizole, atropine, azimilide, azithromycin, bepridil, beta blockers, betel nut, bretylium, budipine, cardiac glycosides, chinese restaurant syndrome, chloroquine, cibenzoline, cisapride, citalopram, clomipramine, clozapine, cocaine, crizotinib, cyanide, desipramine, digitalis, digoxin, diphenhydramine, disopyramide, dofetilide, dolasetron, doxepin, dronedarone, droperidol, eribulin mesylate, fluconazole, gingko biloba, glatiramer acetate, grepafloxacin, halofantrine, haloperidol, ibutilide, imipramine, indapamide, inotropes, insulin, ketanserin, ketoconazole, lidoflazine, lubeluzole, methadone, methadyl acetate, methamphetamine, midodrine, mizolastine, moxifloxacin, naratriptan, neuroleptics, nicardipine, nicotine, nilotinib, nitrates, ondansetron, pasireotide, pazopanib, pentamidine, phenothiazines, pimozide, piperaquine, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, ranolazine, retigabine, ritodrine, ritonavir, saquinavir, senna, serotonin syndrome, sertindole, sotalol, sparfloxacin, sympathomimetics, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, theophylline, thioridazine, thyroxine, vandetanib, vemurafenib, venlafaxine, vernakalant, voriconazole, vorinostat, ziprasidone, zotepine, zuclopenthixol
Psychiatric	Acrophobia, anorexia nervosa, anxiety disorder, chronic fatigue syndrome, panic attack, phobias, psychiatric disorders, social phobia
Pulmonary	Cor pulmonale, hyperventilation, hypoxemia, hypoxia, obstructive sleep apnea, respiratory acidosis, sleep apnea
Renal / Electrolyte	Renal artery stenosis, renal tubular acidosis
Rheum / Immune / Allergy	Amyloidosis, pernicious anemia, rheumatic fever
Sexual	No underlying causes
Trauma	Electrical injury, myocardial contusion
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, alcohol withdrawal, caffeine, exercise, holiday heart syndrome, nicotine withdrawal, zero gravity

Causes in Alphabetical Order

Acid-base disturbances Acidosis Acrophobia Acute coronary syndrome Acute starvation Adrenal tumor Alcohol Alcohol withdrawal Alcoholic cardiomyopathy Aldosteronism Alimemazine Almokalant Aminophylline Amiodarone Amitriptyline Amphetamines Amyloidosis Anagrelide Andersen cardiodysrhythmic periodic paralysis Anemia Angina Anorexia nervosa Antiarrythmics Antidepressants Anxiety Anxiety disorder Aortic aneurysm Aortic regurgitation Aortic stenosis Aplastic anemia Arrhythmia Arrhythmogenic right ventricular dysplasia Arsenic trioxide Arsenicals Arteriovenous fistula Asenapine Astemizole Atrial fibrillation Atrial flutter Atrial myxoma Atrial septal defect Atrioventricular heart blocks Atropine Atypical angina Autonomic neuropathy AV block AV nodal re-entry tachycardia Azimilide Azithromycin Bepridil Beta blockers Betel nut Bradyarrhythmias Bretylium Butorphanol Buprenorphine/naloxone Budipine Caffeine Carbon monoxide Cardiac glycosides Cardiac syndrome X Cardiomegaly Cardiomyopathy Cardioversion Catecholaminergic polymorphic ventricular tachycardia Chagas disease Channelopathies Chinese restaurant syndrome Chloroquine Chronic fatigue syndrome Cibenzoline Cisapride Citalopram Clomipramine Clozapine Cocaine Congenital heart disease Congestive heart failure Cor pulmonale Coronary artery disease Crizotinib Cyanide De Quervain's thyroiditis Defibrillation Dermatomyositis Desipramine Desmopressin Digitalis Digoxin Diphenhydramine Disopyramide Dofetilide Dolasetron Doxepin Dronedarone Droperidol Dumping syndrome Efavirenz Electrical injury Electrolyte Imbalance Electrophysiologic studies Goiter

Endomyocardial eosinophilic fibrosis Eribulin mesylate Exercise Extrasystoles Fever Fluconazole Friedreich's ataxia Ganglioneuroma Gingko biloba Glatiramer acetate Glucose-6-phosphate dehydrogenase deficiency Graves' disease Grepafloxacin Halofantrine Haloperidol Hashimoto's thyroiditis Heart attack Heart block Heart failure Heart murmurs Heart surgery Heat exhaustion Heat illness Hemochromatosis Hemolytic anemia Holiday heart syndrome Hookworm infection Hyperkalemia Hyperkinetic heart syndrome Hyperpituitarism Hypertension Hypertensive cardiomyopathy Hyperthyroidism Hypertrophic cardiomyopathy Hyperventilation Hypocalcemia Hypoglycemia Hypokalemia Hypomagnesemia Hypoparathyroidism Hypotension Hypothermia Hypothyroidism Hypoxemia Hypoxia Ibutilide Imipramine Indapamide Inotropes Insecticide Insulin Iron deficient anemia Ischaemic heart disease Jervell and Lange-Nielsen syndrome Junctional tachycardia Ketanserin Ketoconazole Left bundle branch block Lidoflazine Long QT syndrome Lown Ganong Levine syndrome Lubeluzole Lyme disease Lymphocytic thyroiditis Malignant hypertension Megaloblastic anemia Menopause Metabolic acidosis Methadone Methadyl acetate Methamphetamine Midodrine Migraine Milnacipran hydrochloride Mitral regurgitation Mitral stenosis Mitral valve prolapse Mizolastine Moxifloxacin Multiple endocrine neoplasia type 1 Myocardial contusion Myocardial infarction Myocardial ischemia Myocarditis Myotonic dystrophy Nabilone Naratriptan Neuroleptics Niacin Nicardipine Nicotine Nicotine withdrawal Nilotinib Nitrates NSTEMI Obstructive sleep apnea Ondansetron Oprelvekin Oxaprozin Pacemaker Panic attack Paroxysmal atrial tachycardia Paroxysmal nocturnal hemoglobinuria Paroxysmal supraventricular tachycardia

Pasireotide Patent ductus arteriosus Pazopanib Pentamidine Pericardial tamponade Pergolide Pernicious anemia Phenothiazines Pheochromocytoma Phobias Pimozide Piperaquine Pituitary adenoma Postpartum cardiomyopathy Premature atrial contractions Premature ventricular contractions Prenylamine Prinzmetal's angina Probucol Procainamide Propoxyphene Prosthetic heart valve Psychiatric disorders Pulmonary artery catheter Pulmonary embolism Pulmonary hypertension Quinidine Quinine Ranolazine Renal artery stenosis Renal tubular acidosis Respiratory acidosis Restrictive cardiomyopathy Retigabine Rheumatic fever Right bundle branch block Right heart catheterisation Right ventricular outflow tract tachycardia Riociguat Ritodrine Ritonavir Romano-Ward syndrome Saquinavir Schistosomiasis Scorpion sting Second degree heart block Senna Serotonin syndrome Sertindole Short QT syndrome Short QT syndrome type 1 Short QT syndrome type 2 Short QT syndrome type 3 Short QT syndrome type 4 Short QT syndrome type 5 Sick sinus syndrome Sickle cell anemia Siltuximab Sinus tachycardia Sleep apnea Social phobia Sotalol Sparfloxacin Spherocytosis STEMI Sympathomimetics Tachyarrhythmia Tedisamil Telithromycin Terbutaline Terfenadine Terodiline Tetrabenazine Theophylline Thioridazine Third degree heart block Thyroiditis Thyroxine Tiagabine Timothy syndrome Torsade de pointes Tricuspid insufficiency Typhus Unstable angina Vaginal bleeding Valvular heart disease Vandetanib Vasovagal syncope Vemurafenib Venlafaxine Ventricular aneurysm Ventricular arrhythmia Ventricular septal defect Ventricular tachycardia Vernakalant Vilazodone Von Hippel-Lindau disease Voriconazole Vorinostat Wolff Parkinson White syndrome Zero gravity Ziprasidone Zotepine Zuclopenthixol