GERD-Related Palpitations: Diagnostic and Management Considerations

Clinical Presentation and Diagnosis

• The American College of Cardiology recommends ruling out primary cardiac causes first, obtaining a 12-lead ECG to exclude supraventricular tachycardia, which presents with regular paroxysmal palpitations with abrupt onset and termination 1
• Heartburn and regurgitation are present in 89% of gastroenterology patients with GERD, though extraesophageal manifestations can occur without GI symptoms in up to 75% of cases 2, 3

Important Clinical Caveats

• The American Heart Association suggests that palpitations associated with heart rates >150 beats per minute are more likely to represent primary cardiac pathology 4
• The combination of palpitations with other symptoms demands broader investigation, and avoiding treating palpitations in isolation with antiarrhythmic medications or beta-blockers before establishing the underlying diagnosis is recommended 1

Management Strategy

• The treatment approach should prioritize addressing the underlying GERD, and avoiding treating palpitations in isolation with antiarrhythmic medications or beta-blockers before establishing the underlying diagnosis is recommended 1