possible cause Nicotine, the addictive substance in tobacco, can cause palpitations, as can some recreational drugs. Inhaling solvents may result in potentially fatal palpitations.

action Try to stop smoking or, at least, cut down on the amount you smoke. Do not take recreational drugs or inhale solvents. If your symptoms persist or if you need help with stopping smoking or coming off drugs, consult your doctor. He or she may be able to advise you or refer you to a relevant self-help group (see Useful addresses, p.311).

Continued on next page see your doctor within 24 hours

Possible cause and action Certain drugs, including some used to treat heart disorders, may cause palpitations as a side effect. Stop taking over-the-counter drugs. Do not stop taking your prescription drugs unless your doctor advises you to do so.

see your doctor within 24 hours possible cause A disorder of the heart or its blood vessels may have caused the palpitations. You need to see your doctor so that further episodes can be prevented.

action Your doctor will examine you and may refer you to hospital for tests including ambulatory electrocardiography (opposite) to detect intermittent abnormalities of heart rate or rhythm. Treatment depends on the results but may include antiarrhythmic drugs.


Caffeine is present in varying amounts in tea, coffee, chocolate, and some soft drinks, notably cola. Filter coffee contains about twice as much caffeine as instant coffee, which has about twice the amount of caffeine that tea contains.

Caffeine stimulates the nervous system, making you feel more energetic. It also increases the amount of urine produced. Small amounts of caffeine do no harm, but in large doses, it may produce symptoms such as palpitations, trembling, and sleeplessness. Some people are more likely to develop these symptoms than others.

Try to gradually cut down your caffeine intake to 2 cups of coffee a day or less. Sudden withdrawal of caffeine may cause symptoms such as headaches.

Continued from previous page

Do you have any of the following symptoms?

• Weight loss with increased appetite

• Feeling constantly on edge

Have you been feeling generally tired, been short of breath after mild exercise, and do you have pale skin?

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