Palpitations

This review outlines the clinical features, evaluation, and differential diagnosis of palpitations, which are defined as an uncomfortable awareness of the heartbeat that may be rapid, forceful, or irregular. Their causes can be broadly categorized into physiological, non-cardiac, and cardiac conditions, including both arrhythmic and non-arrhythmic heart diseases. A careful history and physical examination are essential for diagnosis. Key elements include symptom onset, duration, rhythm characteristics, and associated symptoms such as syncope, chest pain, or dyspnea. Important non-cardiac causes include thyrotoxicosis, hypoglycemia, anemia, and psychiatric disorders. Medication use and lifestyle factors should also be assessed. Diagnostic evaluation typically includes a 12-lead electrocardiogram, chest radiography, and laboratory testing. Ambulatory ECG monitoring is useful for detecting intermittent arrhythmias. Although smartwatch-based ECG devices are increasingly available, their role remains supportive. The prognosis of palpitations is generally favorable; however, serious arrhythmias may lead to adverse outcomes, including sudden cardiac death. Clinicians should consider both cardiac and non-cardiac causes and remain vigilant for potentially life-threatening conditions. The presented case highlights thyrotoxicosis as an important cause of palpitations.