Palpitations are a subjective sensation of forceful, rapid, or irregular heartbeats. In one study, palpitations accounted for 7 in 10,000 pediatric ED visits. Patients and families often present with high levels of concern. The etiology of palpitations is most commonly due to benign physiologic causes such as anxiety, fear, exercise, or fever. Nonetheless, it is important to assess for less common pathologic causes including abnormal rhythms as an isolated problem or in association with an underlying syndrome or structural heart defect. In the previously mentioned study, 13.5% of patients were found to have an arrhythmia, with SVT being the most common. The initial evaluation of palpitations should focus on distinguishing palpitations due to benign physiologic causes from palpitations caused by an arrhythmia with or without underlying heart disease.
