Palpitation

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 History 4 Clinical-manifestations 5 Laboratory 6 Diagnostic-procedures 7 Radiology 8 Management 9 More General Terms 10 Additional Terms 11 References

Introduction

• Any uncomfortable awareness of heartbeats. It does not necessarily imply a rapid heartbeat. Palpitations may be described as pounding, flopping, skipping, jumping, fluttering or thumping.

Etiology

• conditions with sinus tachycardia

• anxiety, panic disorder
• exercise
• fever
• stress
• menopause

• pharmacologic agents

• decrease in vagal activity

• anticholinergic agents
• nicotine

• increase in adrenergic activity

• coffee
• adrenergic agents

• high cardiac output states

• anemia
• thyrotoxicosis
• pregnancy

• arrhythmias

• premature atrial contractions ( PACs)
• premature ventricular contractions ( PVC)
• atrioventricular ( AV) block
• bradyarrhythmias
• sick sinus syndrome
• Wolff-Parkinson-White ( WPW) syndrome
• atrial fibrillation
• atrial flutter
• paroxysmal supraventricular tachycardia
• ventricular tachycardia

• other serious conditions

• myocardial infarction
• myocardial ischemia
• hypokalemia
• hypomagnesemia
• valvular heart disease
• hypoxia
• pheochromocytoma

History

• dizziness, nausea, dyspnea, edema, chest pain, pleuritic chest pain, syncope, weakness, fatigue, diaphoresis

Clinical-manifestations

• history

• relationship to stress or exercise
• chest pain
• shortness of breath
• dizziness
• pharmaceutical agents, over the counter agents
• illicit drugs
• history of heart problems
• fever
• anxiety
• feeling of heart stopping, fluttering or irregular heartbeat are most predictive symptoms of arrhythmia

• physical findings

• generally normal physical exam
• tachycardia
• hypertension
• abnormal heart sounds

Laboratory

• complete blood count with peripheral smear
• thyroid function tests
• serum K+
• serum Mg+2

Diagnostic-procedures

• electrocardiogram ( ECG) during an episode of palpitations is the most useful laboratory test
• event recorder is twice as likely as HOLTER to document an arrhythmia
• echocardiography
• exercise stress test (if exercise-related)

Radiology

• chest radiograph

Management

• therapy aimed at underlying etiology

• palpitations unrelated to exercise, anxiety or drugs suggest an arrhythmia

• general measures

• reassurance: most palpitations are benign
• behavioral modification

• smoking cessation
• limiting caffeine & alcohol intake
• discontinuation of causative drugs
• stress reduction

• situations warranting cardiology referral

• sustained supraventricular tachycardia
• ventricular tachycardia
• Wolf-Parkinson-White syndrome
• syncope or dizziness associated with palpitations
• unexplained arrhythmia associated with palpitations

More General Terms

• sign/symptom

Additional Terms

• event monitoring (event recording, loop recording)
• HOLTER

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 205-7
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998

palpitations