Treatment Options for Heart Palpitations

Initial Evaluation

• The American College of Cardiology and European Heart Society recommend determining if palpitations are associated with hemodynamic compromise, which may require urgent treatment, in patients with symptoms of heart palpitations 3
• The American Heart Association suggests identifying potential triggers such as caffeine, alcohol, cigarettes, stimulant medications, and electrolyte abnormalities in patients with heart palpitations 1, 3

Treatment Based on Underlying Cause

• The American College of Cardiology recommends beta blockers as the first-line treatment for symptomatic palpitations, particularly when associated with mild tachyarrhythmias or increased adrenergic symptoms, with a strength of evidence level of I 1, 2
• The European Heart Society suggests that non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, are effective alternatives for patients who cannot tolerate beta blockers, with a strength of evidence level of IIa 2, 5
• The American College of Cardiology recommends adenosine as the drug of choice for terminating AV nodal re-entrant tachyarrhythmias, with a strength of evidence level of I 5

Special Considerations

• The American Heart Association suggests that for patients with orthostatic symptoms and palpitations, volume expansion through liberal fluid and salt intake, and support stockings may be beneficial 1
• The European Heart Society recommends beta blockers for patients with mitral valve prolapse and palpitations, with a strength of evidence level of IIa 1, 8

When to Refer to Cardiology

• The American College of Cardiology recommends referring patients with sustained ventricular arrhythmias to cardiology, with a strength of evidence level of I 9
• The European Heart Society suggests considering electrophysiologic testing or catheter ablation for recurrent symptomatic arrhythmias, with a strength of evidence level of IIb 2

Monitoring and Follow-up

• The American College of Cardiology recommends periodic reassessment of ventricular function in patients with frequent PVCs, with a strength of evidence level of IIa 2