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PALPITATION
A. Definition.   Abnormal subjective awareness of the heart    beat.   Thumping, pounding, fluttering, jumping, racing, ...
B. Causes.   Palpitation may be due to   Rapid heart beat or                                Slow heart beat or           ...
Common causes are  (1) Anxiety, Exercise, hyperthyroidism  (2) Drugs         (Sympathomimetics, Atropine)  (3) Diet       ...
(6) Abnormal rhythms            Atrial fibrillation            Ventricular fibrillation(7) Extrasystole            Atrial ...
Sinus Tachycardia . Heart rate = 100 bpm-160bpm Causes Fever           Thyrotoxicosis        Anaemia         Phaeochromocy...
Sinus bradycardiaHeart rate = < 60 bpmCauses    Myocardial infarction          Sick sinus syndrome          Hypothermia   ...
Supraventricular Tachycardia (SVT)Ventricular Tachycardia (VT) Heart rate (140-220) Causes         Coronary artery disease...
Paroxysmal atrial tachycardia (PAT). Heart rate is usually about 140-220 during attack. Clinical feature     Asymptomatic....
Treatment Carotid sinus massage. Increases vagal tone by induced vomiting, Valsalva  manoeuvre. Inj IV Adenosine or IV ...
Atrial Fibrillation.Causes. Coronary artery disease   Alcohol Valvular heart disease    Hypertension Cardiomyopathy       ...
ECG         No P wave.            Fibrillatory wave.            Normal but amplitude of QRS complex.Treatment        Digox...
ExtrasystolesPremature beats or premature contractions.  a. Atrial extrasystole.  b. Ventricular extrasystole.Clinical fea...
ECGAE Normal QRS complex with preceding abnormal P wave.VE Broad and bizarre QRS without preceding    P wave.    Couplet  ...
VE   Healthy    more prominent at rest    tend to disappear with exercise    treatment is unnecessary    low dose β block...
Wolff-Parkinson-White (WPW) syndromePre-excitation syndrome   Presence of extra conducting tissue (bundle of Kent).   EC...
C. Diagnosis   Careful and thorough history is important.   Definitive diagnosis may be obtained by doing    ECG during ...
The evaluation of patient with palpitation.   Continuous or intermittent?   Regular or irregular heartbeat?   Approxima...
Regular heart beat      NO                                       YesEctopicsAtrial fibrillation             Discrete attac...
Palpitation
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Palpitation

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Palpitation

  1. 1. PALPITATION
  2. 2. 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
  3. 3. 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)
  4. 4. Common causes are (1) Anxiety, Exercise, hyperthyroidism (2) Drugs (Sympathomimetics, Atropine) (3) Diet (Tea, coffee, cola) (4) Nicotine(Smoking) (5) Abnormal rate Sinus tachycardia(100-160) Supraventricular tachycardia(160-220) Ventricular tachycardia Sinus Bradycardia
  5. 5. (6) Abnormal rhythms Atrial fibrillation Ventricular fibrillation(7) Extrasystole Atrial extrasystole. Ventricular extrasystole(8) Wolff-Parkinson-White (WPW)(9) Forceful heart beat Aortic regurgitation.
  6. 6. Sinus Tachycardia . Heart rate = 100 bpm-160bpm Causes Fever Thyrotoxicosis Anaemia Phaeochromocytoma Anxiety Carcinoid tumor Exercise Heart failure Pregnancy Drugs
  7. 7. Sinus bradycardiaHeart rate = < 60 bpmCauses Myocardial infarction Sick sinus syndrome Hypothermia Hypothyroidism Cholestatic jaundice Raised intracranial pressure Drugs (Digoxin, Beta blockers.)Treatment Atropine
  8. 8. 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
  9. 9. 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
  10. 10. 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.
  11. 11. Atrial Fibrillation.Causes. Coronary artery disease Alcohol Valvular heart disease Hypertension Cardiomyopathy Pulmonary embolism Pericarditis Congenital heart disease Thyrotoxicosis Pneumonia Idiopathic Bronchial carcinoma
  12. 12. ECG No P wave. Fibrillatory wave. Normal but amplitude of QRS complex.Treatment Digoxin Amioderone Cardioversion β blocker Verapamil Antiplatelets
  13. 13. 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.
  14. 14. 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
  15. 15. 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)
  16. 16. Wolff-Parkinson-White (WPW) syndromePre-excitation syndrome Presence of extra conducting tissue (bundle of Kent). ECG 1. Short PR interval (< 0.1 sec.) 2. Delta wave. 3. Wide QRS complex (> 0.1 sec.) Complications Paroxysmal atrial tachycardia(PAT). Atrial fibrillation (Af). Trans-venous radiofrequency catheter ablation Amiodarone, Disopyramide, Flecainide Contrindication – Digoxin, verapamil
  17. 17. C. Diagnosis Careful and thorough history is important. Definitive diagnosis may be obtained by doing ECG during attacks or ambulatory ECG monitoring.
  18. 18. 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.
  19. 19. Regular heart beat NO YesEctopicsAtrial fibrillation Discrete attacks Yes NO SVT Sinus tachycardia High stroke volume Anaemia Anxiety AR

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