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Emergency Department Discharge Instructions

Palpitations/irregular heart beat



Emergency Care Discharge Instructions

Instruction summary

Heart palpitations are common and can have many different causes. Most often, they are caused by extra beats called “premature contractions,” which can occur in any of the four chambers of the heart. Palpitations are most commonly caused by extra heart beats starting in the upper two chambers of the heart, called Premature Atrial Contractions (PACs). PACs are common, and they are not dangerous. PACs can be triggered by stress, caffeine, illegal drugs (cocaine, methamphetamines), weight loss pills, thyroid pills, asthma inhalers and other medications. Some people are just predisposed to them, just like some people have birthmarks.

Sometimes the palpitations are caused by extra heart beats starting in the lower chambers of the heart, called Premature Ventricular Contractions (PVCs). These are also not dangerous except in the setting of a having a heart attack (i.e. you have chest pain, shortness of breath, etc).

Extra heart beats happen when some cells in your heart, which usually do not trigger heart beats, start to fire and trigger heart beats. Similar to a muscle twitching in the eyelid, this usually goes away its own (and any triggers are removed).

There are two tests that your family doctor will likely schedule for you
  1. A Holter monitor test. This is a device which you wear around your neck for 24 - 48 hours, and is used to track your heart rate, so that the doctor can see what your heart palpitations look like.
  2. An echocardiogram or “echo.” This is an ultrasound of your heart to look at the size of your heart, which may be worsening the heart palpitations.

Try to eliminate any causes for your palpitations such as caffeine, illegal drugs and stress. Remember, tea, cola and chocolate also contain caffeine.

Reasons to return to the ER
  1. Episodes of very frequent palpitations that are not going away after a few hours
  2. Chest pain or tightness
  3. Shortness of breath or feeling light-headed with your palpitations