Palpitations

Defined as a conscious awareness of one's heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping or as missing or skipping beats. Palpitations may be regular or irregular, fast or slow, paroxysmal or sustained.

Although usually insignificant, palpitations may result from a cardiac or metabolic disorder and from the effects of certain drugs. Nonpathologic palpitations may occur with a newly implanted prosthetic valve because the valve's clicking sound heightens the patient's awareness of his heartbeat. Transient palpitations may accompany emotional stress (such as fright, anger, or anxiety) or physical stress (such as exercise and fever). They can also accompany the use of stimulants, such as tobacco and caffeine.

To help characterize the palpitations, ask the patient to simulate their rhythm by tapping his finger on a hard surface. An irregular “skipped beat” rhythm points to premature ventricular contractions, whereas an episodic racing rhythm that ends abruptly suggests paroxysmal atrial tachycardia.

Action stat!

If the patient complains of palpitations, ask him about dizziness and shortness of breath. Then inspect for pale, cool, clammy skin. Take the patient's vital signs, noting hypotension and an irregular or abnormal pulse. If these signs are present, suspect cardiac arrhythmia. Place the patient on a cardiac monitor. Insert an I.V. catheter to administer an antiarrhythmic, if needed. Prepare for cardioversion or defibrillation if necessary.

History and physical examination

If the patient isn't in distress, perform a complete cardiac history and physical examination. Ask if he has a cardiovascular or pulmonary disorder, which may produce arrhythmias. Does the patient have a history of hypertension or hypoglycemia? Be sure to obtain a drug history. Has the patient recently started cardiac glycoside therapy? Also, ask about caffeine, tobacco, and alcohol consumption.

Then explore associated symptoms, such as weakness, fatigue, and angina. Finally, auscultate for gallops, murmurs, and abnormal breath sounds.

Medical causes

Anxiety attack (acute).With anxiety, palpitations may be accompanied by diaphoresis, facial flushing, trembling, and an impending sense of doom. Almost invariably, patients hyperventilate, which may lead to dizziness, weakness, and syncope. Other typical findings include tachycardia, precordial pain, shortness of breath, restlessness, and insomnia.

Cardiac arrhythmias.Paroxysmal or sustained palpitations of a cardiac arrhythmias may be accompanied by dizziness, weakness, and fatigue. The patient may also experience an irregular, rapid, or slow pulse rate; decreased blood pressure; confusion; pallor; oliguria; and diaphoresis.

Hypertension.With hypertension, the patient may be asymptomatic or may complain of sustained palpitations alone or with headache, dizziness, tinnitus, “blackouts,” and fatigue. His blood pressure typically exceeds 140/90 mm Hg. He may also experience nausea and vomiting, seizures, and decreased level of consciousness.

Hypocalcemia.Typically, hypocalcemia produces palpitations, weakness, and fatigue. It progresses from paresthesia to muscle tension and carpopedal spasms. The patient may also exhibit muscle twitching, hyperactive deep tendon reflexes, chorea, and positive Chvostek's and Trousseau's signs.

Mitral prolapse.Mitral prolapse may cause paroxysmal palpitations accompanied by sharp, stabbing, or aching precordial pain. The hallmark of this disorder, however, is a midsystolic click followed by an apical systolic murmur. Associated signs and symptoms may include dyspnea, dizziness, severe fatigue, a migraine headache, anxiety, paroxysmal tachycardia, crackles, and peripheral edema.

Mitral stenosis.Early features of mitral stenosis typically include sustained palpitations accompanied by exertional dyspnea and fatigue. Auscultation also reveals a loud S₁ or opening snap and a rumbling diastolic murmur at the apex. Patients may also experience related signs and symptoms, such as an atrial gallop and, with advanced mitral stenosis, orthopnea, dyspnea at rest, paroxysmal nocturnal dyspnea, peripheral edema, jugular vein distention, ascites, hepatomegaly, and atrial fibrillation.

Thyrotoxicosis.A characteristic symptom of thyrotoxicosis, sustained palpitations may be accompanied by tachycardia, dyspnea, weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, heat intolerance and, possibly, exophthalmos and an enlarged thyroid. The patient may also experience an atrial or a ventricular gallop.

Other causes

Drugs.Palpitations may result from drugs that precipitate cardiac arrhythmias or increase cardiac output, such as cardiac glycosides; sympathomimetics, such as cocaine; ganglionic blockers; beta-adrenergic blockers; calcium channel blockers; atropine; thyroid supplements; and minoxidil.

Nursing considerations

▪ Prepare the patient for diagnostic tests, such as an electrocardiogram and Holter monitoring.

▪ Maintain a quiet, comfortable environment to minimize anxiety and perhaps decrease palpitations.

▪ Monitor for signs of reduced cardiac output and cardiac arrhythmias.

▪ Prepare the patient for cardioversion, if indicated.

▪ Provide supplemental oxygen.

Patient teaching

▪ Explain all diagnostic tests and procedures.

▪ Teach the patient how to reduce anxiety.

▪ Explain the disorder and treatment plan.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Palpitations

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Palpitations

• Back to symptom: Palpitations: Introduction (review 510 causes)
• Next Book Extract About Palpitations: MURMURS (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Palpitations

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: MURMURS (Differential Diagnosis in Primary Care)

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