Search
palpitations
Any uncomfortable awareness of heartbeats. It does not necessarily imply a rapid heartbeat. Palpitations may be described as pounding, flopping, skipping, jumping, fluttering or thumping.
Etiology:
1) conditions with sinus tachycardia
- anxiety, panic disorder
- exercise
- fever
- stress
- menopause
2) pharmacologic agents
a) decrease in vagal activity
- anticholinergic agents
- nicotine
b) increase in adrenergic activity
- coffee (caffeine)
- adrenergic agents
c) vasodilators causing reflex tachycardia [3]
3) high cardiac output states
- anemia
- thyrotoxicosis
- pregnancy
4) arrhythmias
- premature atrial contractions (PACs)
- premature ventricular contractions (PVC)
- atrioventricular (AV) block
- bradyarrhythmias
- sick sinus syndrome
- Wolff-Parkinson-White (WPW) syndrome
- atrial fibrillation
- atrial flutter
- paroxysmal supraventricular tachycardia
- ventricular tachycardia
5) other serious conditions
- myocardial infarction
- myocardial ischemia
- hypokalemia
- hypomagnesemia
- valvular heart disease
- hypoxia
- pheochromocytoma
- hypoglycemia
History:
- relationship to stress or exercise
- chest pain
- pleuritic chest pain
- dyspnea
- dizziness
- nausea
- edema
- syncope
- weakness
- fatigue
- diaphoresis
- fever
- anxiety
- pharmaceutical agents, over the counter agents, illicit drugs
- history of heart problems
Clinical manifestations:
1) symptoms
- feeling of heart stopping, fluttering or irregular heartbeat are most predictive symptoms of arrhythmia
2) signs
- generally normal physical exam
- tachycardia
- hypertension
- abnormal heart sounds
Laboratory:
1) complete blood count with peripheral smear
2) thyroid function tests
3) serum K+
4) serum Mg+2
Special laboratory:
1) electrocardiogram (ECG) during an episode of palpitations is the most useful laboratory test
2) event recorder is twice as likely as HOLTER to document an arrhythmia
3) echocardiography
4) exercise stress test (if exercise-related)
Radiology:
- chest radiograph
Management:
1) therapy aimed at underlying etiology
- palpitations unrelated to exercise, anxiety or drugs suggest an arrhythmia
2) general measures
a) reassurance: most palpitations are benign
b) behavioral modification
- smoking cessation
- limiting caffeine & alcohol intake
- discontinuation of causative drugs
- stress reduction
3) situations warranting cardiology referral
- sustained supraventricular tachycardia
- ventricular tachycardia
- Wolf-Parkinson-White syndrome
- syncope or dizziness associated with palpitations
- unexplained arrhythmia associated with palpitations
Related
event monitoring (event recording, loop recording, Zio patch)
HOLTER
General
sign/symptom
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 205-7
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Ali YS
Fast Five Quiz: Heart Palpitations.
Medscape. October 10, 2022
https://reference.medscape.com/viewarticle/981860