Based on WHO | Are heart palpitations a symptom of mesothelioma, and what might cause them?

Mesothelioma and Heart Palpitations: What to Know

Heart palpitations (the feeling that your heart is racing, fluttering, or skipping beats) are not among the most common symptoms of pleural or peritoneal mesothelioma, but they can occur in certain situations especially when the cancer involves or affects structures near the heart. The typical symptoms of pleural mesothelioma include chest pain, shortness of breath, painful coughing, fatigue, and weight loss, while peritoneal mesothelioma more often causes abdominal pain, swelling, nausea, fatigue, and weight loss. ^{[1] [2]} In rare forms such as pericardial mesothelioma (cancer arising in the sac around the heart), symptoms may include breathing difficulty and chest pain, and patients may report a rapid or irregular heartbeat. ^{[3] [4]}

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How Mesothelioma Can Lead to Palpitations

• Direct involvement of the heart’s lining (pericardium): Mesothelioma can extend to the pericardium, causing inflammation or fluid buildup (pericardial effusion), which can provoke a rapid or irregular heartbeat and the sensation of palpitations. ^{[5] [6]}
• Mechanical pressure or invasion: Large pleural tumors in the chest or mediastinum can distort or compress cardiac structures and nearby conduction tissue, sometimes triggering atrial fibrillation or other arrhythmias that feel like palpitations. ^{[7] [8]}
• Pericardial effusion and tamponade: Fluid accumulation around the heart can impair normal filling and trigger compensatory tachycardia (fast heart rate) or electrical abnormalities; this can present as palpitations and may be life‑threatening if it progresses to cardiac tamponade. ^{[6] [9]}
• Myocardial invasion or metastasis: In rare cases, tumor can invade the heart muscle and provoke serious rhythm disturbances (for example, ventricular tachycardia), which patients may experience as severe palpitations, dizziness, or fainting. ^{[10] [11]}

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Typical Symptoms vs. Cardiac Symptoms

Pleural mesothelioma most often causes chest pain, shortness of breath, and cough, rather than palpitations. ^{[12] [1]} Pericardial mesothelioma is rare, but when present, it can cause chest pain and breathing difficulty and may lead to palpitations due to irritation of the heart’s lining and rhythm changes. ^{[3] [4]} Even when the primary cancer is pleural, cardiac abnormalities are surprisingly frequent: in one series, most patients had ECG changes and many had arrhythmias such as sinus tachycardia, premature beats, and atrial fibrillation. ^[5] These findings show that while palpitations are not a hallmark early symptom, cardiac rhythm problems can occur in advanced or complicated cases.

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Common Mechanisms Behind Palpitations

• Arrhythmias (abnormal heart rhythms) such as atrial fibrillation or sinus tachycardia due to local tumor stimulation or pressure near pulmonary veins and cardiac tissue. ^{[7] [8]}
• Pericardial effusion leading to low-voltage ECG and electrical alternans (alternating amplitude on ECG), reflecting the heart’s pendular movement in fluid; these changes often improve after fluid drainage. ^{[13] [9]}
• Direct myocardial invasion or pericardial tamponade, both of which may trigger significant rhythm disturbances and hemodynamic instability. ^{[11] [6]}

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When to Seek Urgent Care

Any new palpitations accompanied by chest pain, severe shortness of breath, lightheadedness, fainting, or a rapid heart rate that does not settle should be treated as urgent, as these can signal serious problems such as pericardial tamponade or dangerous arrhythmias. ^[6] Palpitations in the context of mesothelioma, especially with known chest involvement, merit prompt evaluation to exclude pericardial effusion, myocardial invasion, or mediastinal compression. ^{[8] [13]}

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How Doctors Evaluate Palpitations in Mesothelioma

• Electrocardiogram (ECG): Detects rhythm problems (tachycardia, atrial fibrillation, premature beats) and conduction abnormalities common in mesothelioma patients. ^[5]
• Echocardiogram (heart ultrasound): Identifies pericardial effusion and thickening and assesses heart function and tamponade physiology. ^{[5] [6]}
• Chest imaging (CT/MRI): Defines the tumor’s size and location relative to the heart and mediastinum and helps plan treatment. ^[4]
• Continuous monitoring: If symptoms are intermittent, ambulatory ECG monitoring may help capture arrhythmias and guide therapy. ^[5]

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Treatment Approaches

Management focuses on both the palpitations and the underlying cause:

• Pericardial effusion: Pericardiocentesis (drainage) can rapidly relieve symptoms and reduce rhythm instability; further measures may be needed if fluid recurs. ^{[6] [9]}
• Arrhythmias: Medications for rate or rhythm control (for example, beta‑blockers or antiarrhythmics) may be used, tailored to the type of arrhythmia and overall health status. ^[8]
• Addressing tumor burden: Oncology treatment plans (surgery, chemotherapy, radiation) may reduce mechanical pressure and secondary cardiac effects when appropriate and feasible. ^{[12] [1]}
• Supportive care: Oxygen, careful fluid management, and treatment of pain and anxiety may help reduce triggers for palpitations. ^[6]

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Key Takeaways

• Palpitations are not a classic early symptom of pleural or peritoneal mesothelioma, but they can occur, particularly with pericardial involvement, large mediastinal masses, pericardial effusion, or myocardial invasion. ^{[1] [8]}
• Any new or worsening palpitations in someone with mesothelioma should be evaluated, as they can signal arrhythmias or serious complications like pericardial tamponade. ^{[6] [5]}
• Diagnostic tools such as ECG, echocardiography, and cross‑sectional imaging are useful to pinpoint the cause and guide treatment. ^{[5] [4]}

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Quick Reference Table: Mesothelioma and Palpitations

Scenario	How palpitations arise	Key tests	Typical actions
Pleural mesothelioma with mediastinal mass	Mechanical stimulation/compression near cardiac tissue causing atrial fibrillation or tachycardia	ECG, chest CT/MRI	Antiarrhythmics as needed; oncologic debulking/therapy if feasible
Pericardial mesothelioma	Irritation of the heart’s lining and effusion leading to rhythm instability	ECG, echocardiogram, CT/MRI	Drain effusion (pericardiocentesis), targeted cancer therapy
Malignant pericardial effusion (any cancer, including mesothelioma)	Fluid around heart triggers tachycardia/alternans and can progress to tamponade	ECG (low voltage/alternans), echocardiogram	Urgent drainage; manage underlying malignancy
Myocardial/pericardial invasion	Direct tumor invasion causes serious arrhythmias (e.g., ventricular tachycardia)	ECG, imaging, sometimes biopsy/autopsy	Antiarrhythmics, palliative/oncologic care

If you ever notice palpitations with chest pain, breathlessness, or fainting, it would be prudent to seek urgent assessment to rule out pericardial effusion or dangerous arrhythmias. ^{[6] [5]}