A. Definition. Abnormal subjective awareness of the heart beat. Thumping, pounding, fluttering, jumping, racing, skipping) But patient may describe palpitation as a feeling of breathlessness, excitement, fright etc. Palpitation ≠ arrythmias
B. Causes. Palpitation may be due to Rapid heart beat or Slow heart beat or Irregular heart beat. Palpitation may be due to Primary cardiac disease (Acute or Chronic) or Secondary effect on the heart (Systemic disease or Drugs)
Supraventricular Tachycardia (SVT)Ventricular Tachycardia (VT) Heart rate (140-220) Causes Coronary artery disease. Valvular heart disease. Myocarditis. Cardiomyopathy. Drugs. SVT usually benign. VT always malignant and need urgent treatment. DC cardiovertion Lignocaine, Mexilatine, Flecainide, K, Mg
Paroxysmal atrial tachycardia (PAT). Heart rate is usually about 140-220 during attack. Clinical feature Asymptomatic. Symptomatic Palpitation Dyspnoea Cheat pain Fainting Sudden onset and sudden disappear. Polyuria (due to Atrial Natriuretic peptide) ECG Normal or WPW syndrome during intervals. SVT during attack
Treatment Carotid sinus massage. Increases vagal tone by induced vomiting, Valsalva manoeuvre. Inj IV Adenosine or IV Verapamil Alternative drugs Beta-blockers. Disopyramide. Digoxin. DC cardioversion.Prevention Above drugs Radio frequency ablation.
ECG No P wave. Fibrillatory wave. Normal but amplitude of QRS complex.Treatment Digoxin Amioderone Cardioversion β blocker Verapamil Antiplatelets
ExtrasystolesPremature beats or premature contractions. a. Atrial extrasystole. b. Ventricular extrasystole.Clinical features Asymptomatic. Symptomatic. Palpitation Irregular beats Missed beat or Strong beat. heart sound have missed or extra beats.
ECGAE Normal QRS complex with preceding abnormal P wave.VE Broad and bizarre QRS without preceding P wave. Couplet 2 successive ectopic beat. Triplet 3 successive ectopic beat. Bigeminy Alternate sinus and ectopic beat.AE No treatedVE Treatment of underlying diseases
VE Healthy more prominent at rest tend to disappear with exercise treatment is unnecessary low dose β blocker may reduce anxiety and palpitation Heart disease During AMI Heart failure Digoxin toxicity Mitral valve prolapse (MVP)
C. Diagnosis Careful and thorough history is important. Definitive diagnosis may be obtained by doing ECG during attacks or ambulatory ECG monitoring.
The evaluation of patient with palpitation. Continuous or intermittent? Regular or irregular heartbeat? Approximate heart rate? Discrete attacks or not? If yes, is the onset abrupt? Or how do attacks terminate? Any associated symptoms? Eg. Chest pain, lightheadedness, polyuria. Any precipitating factors? Eg. Exercise, alcohol. Evidence of structural heart disease? Eg. Coronary heart disease, valvular heart disease.
Regular heart beat NO YesEctopicsAtrial fibrillation Discrete attacks Yes NO SVT Sinus tachycardia High stroke volume Anaemia Anxiety AR