How to identify the reason for palpitations?

Q. How to identify the reason for palpitations?

Answered by
Dr. Rishu Sharma
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Nov 29, 2016 and last reviewed on: Jun 02, 2023

Hi doctor,

I am suffering from heart palpitations. Also, I have occasional breathlessness. For a while, I used Propranolol. But, it did not work. So, the doctor asked me to do a thyroid test and the result was normal. I do not know what to do. Please help



Welcome to

Palpitations can be out of two types. Sinus arrhythmia (only fast heart rate, but rhythm is normal) and this is not to be worried. Arrhythmias - There are many types of arrhythmias, some are atrial in origin and some are ventricular in origin. If your thyroid profile is normal and you are not relieved by Propranolol, then it can be abnormal rhythms. I would suggest you to go for a test called Holter. It will keep a record of your heartbeat for 24 hours. We can easily see the nature of defective beats and their origin, either atrial or ventricular. I would like to see your ECG, before suggesting any medication. Thank you.

Thank you doctor,

Here is my ECG. Please advise accordingly.



Welcome back to

All the three ECG photos you sent to me are perfectly normal (attachment removed to protect patient identity). Sinus arrhythmia, which is very common in young males is also not there and your ECG is in perfect sinus rhythm that is absolutely normal. Through your history, most likely it can be episodes of sinus tachycardia where heart rate increases for a few seconds or minutes and again settles down to normal. I do not know about your smoking habits. It contains nicotine, which increases heart rate. So, if you are a smoker, please stop smoking. Also, do not take alcohol. I will suggest the following medicines for 21 days. Consult your specialist doctor, discuss with him or her and take the medicine with consent. Take Tablet Ciplar (Propranolol) 10 mg twice daily at 9 AM and 9 PM and Tablet Clonotril (Clonazepam) 0.5mg once daily at 9 PM. To be on the safe side, I would suggest you to go for complete blood profile as less hemoglobin (anemia) is the commonest and the most overlooked causes of palpitation in youngsters. Holter test will be done using a small machine, which is going to keep a record of your heartbeat for 24 hours. If an episode of palpitation repeats itself in 24 hours, it is going to record the nature of the beats at the time of palpitation. You should have also attached your thyroid tests with the ECG as while dealing with palpitations we have to consider everything. A thing which might appear normal to a physician may appear slight abnormal to a cardiologist. As of now there is nothing to worry. Also, take a proper sleep.

Hi doctor.

I do not smoke or drink. I took thyroid test a year back and I lost the report. My hair looks brittle and little dry. Do you think it is anemia? What kind of medicine should I use for iron deficiency? I will try that too. I will try the medicine you mentioned above. I feel dizzy while driving. Do you think it is because of this? I heard ear wax causes that. Please send your reply. Thank you.



Welcome back to

Your ECG is normal. The ECG records the heartbeat of your heart for 30 seconds. Your main complaint is palpitations. If palpitations are not present during those 30 seconds an ECG will record nothing and will be normal. Your thyroid profile is normal and you are a non-smoker and non-alcoholic. I have to take a detailed history of yours before putting you on any medicines as in your case all common causes of palpitations have been ruled out. Brittle hairs can indicate anemia but we can undergo a very easy test complete blood profile which will tell the percentage of hemoglobin in your blood. As Ciplar and Clonotril make you dizzy, I would lower the dose. Please answer me the following. Do you feel lassitude, lethargy, and lack of energy level in your body? Do you ever feel a hissing or roaring sound in your ear? How long does dizziness last? Does palpitation occur at night or in the day? How long does every episode of palpitation last? What are the relieving factors of palpitation? How much time does it take to settle down? How frequently does palpitation occur, daily or weekly? What work do you do? Do you sleep properly? Do you have anyone in the family with the same problem? Do you have social anxiety? Tell me your anxiety levels. As your thyroid profile and ECG are normal, a detailed answer to all these questions is very important before I can prescribe you tests and start with medicines. Do not panic. Write the answers pointwise. Till that time stop all medicines.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
Can implantable cardioverter defibrillator cause AFib?

.. are implanted to terminate an episode of atrial arrhythmia. AFib (atrial fibrillation) is also a type of atrial arrhythmia. The ICD not only provides treatment for atrial arrhythmias, but also provides treatment for ventricular arrhythmias, as well as   Read full

Severe heart palpitations in a 20-year-old man. What can be done?

.. gone through your reports (attachment removed to protect patient identity). All the tests are fine. The cardiologist said your heart is normal. So, you do not have to worry. Tablet Metoprolol has been given for symptomatic relief for your palpitation   Read full

What will happen if I take Potassium chloride tablet without the need?

.. tablet should not be taken without monitoring. Serum potassium level should be done once in every three days. Hyperkalemia (elevated level of potassium) is a very dangerous thing. It can precipitate many sorts of arrhythmias (abnormal heart be   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions.  Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this.  Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades.  Read more»

Ask your health query to a doctor online?

Ask a Cardiologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.