Roger Y. Wong, BMSc, MD, FRCPC, Division of Geriatric Medicine, University of British Columbia, Vancouver Hospital & Health Sciences Centre, Vancouver, BC.

Palpitations are common in ambulatory older people and have a variety of causes. The correlation of palpitations and cardiac arrhythmias is poor. Basic assessment, which includes history taking, physical examination, 12-lead electrocardiogram (ECG), and laboratory data, is necessary but may not be sufficient to diagnose the underlying problem. Ambulatory ECG monitoring can be helpful, depending on the frequency of the palpitations. Continuous-loop event monitors are cost-effective in diagnosing palpitations, and the optimal duration of monitoring is two weeks. The overall clinical outcomes of patients with palpitations are favourable, with low mortality but high recurrence risk.

Key words: palpitations, arrhythmias, assessment, cardiac, older adults.

Roger Wong, BMSc, MD, FRCPC

Division of Geriatric Medicine, Department of Medicine,
University of British Columbia, Vancouver, BC

Palpitations refer to the subjective sensation of a person's own heart beat. These are common complaints in adults 65 years or older, and are often described as uncomfortable. Synonyms of palpitations include "skipped heart beats," "rapid heart beats," "a racing heart," "extra heart beats" and "fibrillation." The exact prevalence of palpitations among older adults remains unclear. Previous studies reported prevalence data between 8.3% and 16%.^1,2 The uncertainty is partly due to a lack of uniform diagnostic criteria for palpitations. It should also be noted that the sensitivity of the symptom of palpitations in predicting cardiac arrhythmias is relatively poor. For instance, in the same study where the prevalence of palpitations among individuals age 60 to 94 years was reported as 8.3%, more individuals (12.6%) actually demonstrated cardiac arrhythmias by 12-lead electrocardiography.¹ Palpitations are also non-specific. Many physiologic reasons may produce palpitations, such as exercise, anxiety and anger.

Etiologies

Palpitations in older adults may result from a variety of causes (see Table 1). As in the management of other geriatric clinical syndromes, the precipitating causes of palpitations may be multiple.