Palpitations

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

Normal heart beat is 60 to 100 beats per minute

Arrhythmias refer to heartbeats that are too slow, too rapid, irregular, or too early

Rapid arrhythmias ( greater than 100 beats per minute) are called tachycardias

Slow arrhythmias ( less than 60 beats per minute) are called bradycardias

Irregular heart rhythms are called fibrillations

When a single heart beat occurs earlier than normal, it is called a premature contraction & causes sensation of a forceful heartbeat

Abnormalities in the atria, ventricles, & the electrical conducting system ( SA node, AV node) can lead to arrhythmias that cause palpitations

Arrhythmias can be atrial or ventricular :--

Atrial arrhythmias includes atrial fibrillation, atrial flutter & paroxysmal atrial tachycardia

-Ventricular arrhythmias includes ventricular tachycardia, & ventricular fibrillations

 

VALVE PROBLEMS:-

Mitral valve prolapse

Mitral stenosis

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

Abnormal heart rhythm

Tightness in the chest

Shortness of breath

Dizziness or light- headedness

Depending on the type of rhythm problem, these symptoms, may be just momentary or more prolonged.

 

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

 

DIAGNOSIS

Most important initial clue to the diagnosis is one's description of the palpitations.

Physical examination include measurement of the vital signs,assessment of the jugular venous pressure and pulse,,auscultation of the chest and precordium

ECG :- Electrical tracing of the heart acitivity is done

Stress test::- to document exercise induced arrhythmias

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

Blood test:- thyroid function test to rule out hyperthyroidism.

serum electrolytes to rule out electrolyte imbalance

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.