palpitations in children

Life threatening cardiac conditions
- Arrhythmia
  - Wolff-Parkinson-White syndrome
  - prolonged QT syndrome
  - cardiac structural abnormalities [congenital heart disease, intracardiac tumors]
- Hypertrophic cardiomyopathy (HCM)
  - present with palpitations or syncope during strenuous exercise caused by atrial fibrillation or ventricular arrhythmia
- Myocarditis
  - most commonly viral in origin, with Coxsackie virus B and other enteroviruses accounting for most cases. Clinical findings of myocarditis include tachycardia out of proportion to fever, poor perfusion, and signs of heart failure.
- Sick sinus syndrome
- Pacemaker malfunction

Life threatening non-cardiac conditions
- Hypoglycemia
  - Early manifestations of hypoglycemia in children and adolescents are caused by the autonomic response to hypoglycemia and may include tachycardia with palpitations, sweating, weakness, tremor, and feelings of nervousness and/or hunger.
  - These symptoms and signs usually occur at higher blood glucose concentrations (between 40 and 70 mg/dL) than the neuroglycopenic signs and symptoms (lethargy, irritability, behavioral abnormalities, seizures, or coma), and may function as a “warning system.”
- Toxic exposure
- Pheochromocytoma
  - are rare neoplasms in children
  - classic triad of symptoms in these disorders consists of
    - episodic headache
    - sweating
    - tachycardia
    - hypertension

Common conditions
- Premature atrial contractions
- Premature ventricular contractions
- Fever, Anemia – Increased metabolic rate
- Exercise
- Catecholamine release
  - associated with exercise, emotional arousal, and psychiatric distress (eg, anxiety, panic attack)
- Hyperventilation syndrome
- Drug-induced (caffeine, herbal medications, dietary supplements, albuterol, isotretinoin)
- Postural orthostatic tachycardia syndrome (POTS)

Other conditions
- Acute rheumatic fever with valvular disease
- Hyperthyroidism
- Mitral valve prolapse