Palpitations

By Author: Oyster and Pearl Hospital
Total Articles: 10
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Palpitations are extremely common and can be best defined as an intermittent “thumping”, “ pounding” or “fluttering”sensation in the chest.
Palpitations are unusual awareness of the heart beat and are reported as “skipped” or “missed” heart beats.
CAUSES
Palpitations are brought about by various causes:
CARDIAC CAUSES- 43%
PSYCHIATRIC CAUSES- 31%
MISCELLANOUS CAUSES- 10%
UNKNOWN CAUSES-16%

CARDIAC CAUSES: -
ARRHYTHMIAS
1.Normal heart beat is 60 to 100 beats per minute
2.Arrhythmias refer to heartbeats that are too slow, too rapid, irregular, or too early
3.Rapid arrhythmias ( greater than 100 beats per minute) are called tachycardias
4.Slow arrhythmias ( less than 60 beats per minute) are called bradycardias
5.Irregular heart rhythms are called fibrillations
6.When a single heart beat occurs earlier than normal, it is called a premature contraction & causes sensation of a forceful heartbeat
7.Abnormalities in the atria, ventricles, & the electrical conducting system ( SA node, AV node) ...
... can lead to arrhythmias that cause palpitations
8.Arrhythmias can be atrial or ventricular :--
9.Atrial arrhythmias includes atrial fibrillation, atrial flutter & paroxysmal atrial tachycardia
10.-Ventricular arrhythmias includes ventricular tachycardia, & ventricular fibrillations

VALVE PROBLEMS:-
1.Mitral valve prolapse
2. Mitral stenosis
3.Aortic regurgitation
OTHERS:- eg. Atrial myxoma

PSYCHIATRIC CAUSES :-
Panic attack or disorder
Anxiety states and / or
Somatization
MISCELLANOUS CAUSES:-
Hyperthyroidism, Ethanol (alcohol), Pheochromocytoma, Tobacco, Caffeine, Stress , Exercise, Anemia, Blood loss, Excessive pain, Lack of oxygen.
Drugs :- Aminophylline, Atropine, Thyroxine, Cocaine, Amphetamines,
Menopause-as a result of fluctuating hormones,palpitations are felt.
Pregnancy-due to hyperdynamic circulation

SYMPTOMS
1.Abnormal heart rhythm
2.Tightness in the chest
3.Shortness of breath
4.Dizziness or light- headedness
5.Depending on the type of rhythm problem, these symptoms, may be just momentary or more prolonged.

6.Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart diseases.

DIAGNOSIS
1.Most important initial clue to the diagnosis is one’s description of the palpitations.
2.Physical examination include measurement of the vital signs,assessment of the jugular venous pressure and pulse,,auscultation of the chest and precordium
3.ECG :- Electrical tracing of the heart acitivity is done
4.Stress test::- to document exercise induced arrhythmias
5.Holter monitoring:-24 hours or longer ECG monitoring using a form of tape recorder which can record the ECG continuously during a 24 hours period. Arrhythmias missed on resting ECG can be detected
6.Blood test:- thyroid function test to rule out hyperthyroidism.
serum electrolytes to rule out electrolyte imbalance
7.2D Echocardiography:- to document the heart’s structure & valve probl

TREATMENT
Palpitations are treated only if patient has signs & symptoms.
Includes treatment of the root cause & symptomatic treatment.
Psychiatric & miscellaneous causes should be treated.
Arrhythmias can be treated with antiarrhythmic drugs.
Pacemaker device can be implanted under the skin below the collar bone & can be used to treat bradycardia & also fast arrhythmias
Electrical cardioversion & Defibrillation can be done in acute settings.
Vagal maneuvers can be done to block the adrenaline forces in the body & to decrease the heart rate.
Radiofrequency ( catheter) ablation done :- destruction of small portions of electrical pathways in the heart using catheter is done.
Implantable cardioverter defibrillators ( ICD) used to deliver an electric shock to the heart if serious arrhythmias detected.
Menopause symptoms can be treated with HRT.
Sustained palpitations are lethal as they increase chances of thromboembolic phenomena.Hence treated with anticoagulation.
Treatment is not a costly affair unless there is invasive procedure required.

PROGNOSIS
The goal of treatment is to allow the patient to return to normal lifestyle with minimal restrictions.