Not All Palpitations Are Dangerous
Ask an Expert. Emergency Physician Dr. Adam Kalwerisky explains how palpitations are evaluated in the ER and which signs matter most.
What is the first thing going through your mind when a patient comes in with palpitations?
The first question is whether this could be a dangerous heart rhythm, also called a malignant arrhythmia.
At the same time, we assess whether the patient is stable or unstable. This means looking at vital signs and overall condition to determine if there is any immediate risk.
We also look for red flags, meaning warning signs that may suggest a more serious underlying problem. We review the EKG, which is a test that records the heart’s electrical activity. Another key question is whether the cause is cardiac, meaning coming from the heart itself, or non-cardiac, such as anxiety, dehydration, or stimulant use.
When do you know it is something serious?
We become more concerned when there are associated red flags.
These include chest pain, shortness of breath, fainting, also called syncope, or significant dizziness. Patients who appear clearly symptomatic or unwell are also more concerning.
These features suggest that the palpitations may be linked to a more serious underlying condition.
What do most patients get completely wrong about palpitations?
Many patients assume that palpitations are always serious.
In reality, most are benign, meaning not dangerous. Common causes include premature beats such as PVCs or PACs, which are extra heartbeats that can feel like a skipped or irregular beat. Other common causes include anxiety or stimulant use, such as caffeine.
The key question is not whether palpitations are present but whether any red flags are present.
THE BOTTOM LINE
Most palpitations are not dangerous, but certain symptoms can signal a more serious problem. The ER focuses on identifying those warning signs quickly and safely.
About the Expert
Dr. Adam Kalwerisky is a Board-Certified Emergency Physician.
This article is for educational purposes only and is not a substitute for medical advice from your own healthcare provider.