Palpitation




Definition


Palpitation is an unpleasant subjective awareness of one’s own heartbeats. This usually occurs as a sensation in the chest of rapid, irregular, or unusually strong heartbeats. The patient describes it as pounding, jumping, racing, irregularity of the heartbeat, a “flip flopping” or “rapid fluttering“ in the chest, or pounding in the neck. Palpitation can be felt in the chest, throat, or neck. The pulse rate may become faster or rarely slower than normal. The term palpitation is used so loosely that specific questions must be asked to determine the exact nature of the symptom.




Causes


Palpitation is one of the most common cardiac symptoms encountered in medical practice, but it poorly corresponds to demonstrable abnormalities. Many palpitations are not serious. However, palpitation may indicate the possible presence of serious cardiac arrhythmias.


Box 32-1 lists causes of palpitation. The differential diagnosis can range from benign etiologies to life-threatening arrhythmias.




  • A high percentage of patients with palpitation have no cause that can be established.



  • Caffeine, a common stimulant, is found in many foods and drinks, such as coffee, tea, hot cocoa, soda, chocolate, and some medicines. Most energy drinks (e.g., Venom, Whoopass, Red Bull, Adrenalin Rush), which are the latest popular fad among youth, contain large doses of caffeine and other legal stimulants, including ephedrine, guarana, taurine, and ginseng.



  • Certain drugs and substances can be identified as causes of palpitation.



  • Some medical conditions, such as hyperthyroidism, anemia, and hypoglycemia, may be the cause of palpitation.



  • Although relatively rare, cardiac arrhythmias and structural heart disease should be looked into as a cause of palpitation. However, most palpitations are not accompanied by arrhythmias, and most arrhythmias are not perceived and reported as palpitations.



  • Rarely, slow heart rates may cause palpitation.



  • Occasionally, a psychogenic or psychiatric cause for the symptoms can be suspected. Some adult patients and adolescents with palpitations have panic disorder or panic attack. Panic attack and arrhythmias may be difficult to distinguish clinically because both may present as palpitations, shortness of breath, and lightheadedness.



BOX 32-1


Normal Physiologic Events


Exercise, excitement, fever


Psychologic or Psychiatric


Fear, anger, stress, anxiety disorders, panic attack or panic disorder


Certain Drugs and Substances


Stimulants: caffeine (coffee, tea, soda, chocolate), some energy drinks, smoking.\


Over-the-counter drugs: decongestants, diet pills, and so on


Drugs that cause tachycardia: catecholamines, theophylline, hydralazine, minoxidil, cocaine


Drugs that cause bradycardia: beta-blockers, antihypertensive drugs, calcium channel blockers


Drugs that cause arrhythmias: antiarrhythmics (some of which are proarrhythmic), tricyclic antidepressants, phenothiazines


Certain Medical Conditions


Anemia


Hyperthyroidism


Hypoglycemia


Hyperventilation


Poor physical condition


Heart Diseases


Certain congenital heart defects that are prone to arrhythmias or that result in a poor physical condition


After surgeries for congenital heart disease: Fontan connection, Senning operation


Mitral valve prolapse


Hypertrophic cardiomyopathy


Dilated cardiomyopathy


Valvular disease: aortic stenosis


Cardiac tumors or infiltrative diseases


Cardiac Arrhythmias


Tachycardia


Bradycardia


Premature atrial contractions


Premature ventricular contractions


Supraventricular tachycardias


Ventricular tachycardias


Atrial fibrillation


Wolff-Parkinson-White preexcitation


Sick sinus syndrome

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Apr 15, 2019 | Posted by in CARDIOLOGY | Comments Off on Palpitation
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