Palpitations

Palpitations are the subjective sensation of the heart beating rapidly, strongly, or irregularly. It often means that a rapid heart rate is occurring, but it can also be seen even when the heart rate is normal, such as in anxious patients. The patient should be asked to describe the palpitations and to demonstrate them by saying or tapping the speed and rhythm of the palpitation sensation. Additionally, teaching the patient to measure his/her pulse during the palpitations may give further clues as to the etiology of the sensation.

Differential Diagnosis

• Premature atrial contractions
• Premature ventricular contractions
• Sinus tachycardia
  –Regular heart rhythm at 100–140 bpm
• Atrial fibrillation
  –Irregularly irregular heart rate
• Atrial flutter
  –Regular heart rhythm at about 150 bpm
• Drugs leading to tachyarrhythmias (e.g., aminophylline, amphetamines, alcohol, atropine, cocaine, coffee, epinephrine, ephedrine, MAO inhibitors, tea, thyroid extract, tobacco)
• Psychiatric disorders (anxiety, panic reactions)
• Anemia (with exertion)
• Heart failure (with exertion)
• Menopausal syndrome (with hot flashes)
• Paroxysmal atrial tachycardia
• Re-entry tachycardias, including Wolff-Parkinson-White syndrome
• Ventricular tachycardia
• Atrioventricular heart blocks
• Junctional tachycardia
• Mitral valve prolapse
• Myocardial ischemia
• Hyperthyroidism-associated arrhythmias
• Severe deconditioning (with exertion)
• Hypoglycemia
• Postural hypotension
• Atrial septal defect
• Adrenal tumor
• Pheochromocytoma

Workup and Diagnosis

• History and physical exam
  –Note duration, frequency, and precipitating factors
  –May be associated with chest pain, dyspnea, diaphoresis, or lightheadedness/syncope
  –Heart rhythm may be regular or irregular
  –May have family history of prolonged QT syndrome, hypertrophic cardiomyopathy, syncope, arrhythmias, or sudden death
• ECG
• 24-hour Holter monitor may be indicated
• Event monitor (if events are infrequent)
• Echocardiogram
• Exercise stress test if exercise-related
• Laboratory studies normally include CBC, electrolytes, glucose, TSH, calcium, magnesium
• Consider drug screen
• Consider cardiology consult
• Electrophysiologic studies may be necessary if symptoms suggest sustained arrhythmia

Treatment

• Attention to airway, breathing, and circulation
• Treat the underlying cause
• Discontinue offending drugs
• Anxiolytics may be needed for significant anxiety
• Administer adenosine, amiodarone and/or other antiarrhythmics, β-blockers, diltiazem, digoxin as indicated for rate control, suppression, or cardioversion
• Electrophysiologic intervention (radiofrequency ablation of re-entrant pathway) may be necessary for symptomatic patients

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Palpitations

Read excerpts from these other book chapters related to Palpitations:

Copyright Details: In a Page: 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 - Diastolic (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Palpitations

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Murmurs - Diastolic (In a Page: Signs and Symptoms)

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• Murmurs - Diastolic (In a Page: Signs and Symptoms)
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• Tachycardia/Palpitations (In A Page: Pediatric Signs and Symptoms)
• MURMURS (Differential Diagnosis in Primary Care)
• TACHYCARDIA (Differential Diagnosis in Primary Care)

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