Palpitations
Overview
Palpitations are the abnormal perception of one's heartbeat, whether it be fast, irregular or heavy-beating.
Aetiology
Causes
Cardiac Arrhythmia
- Sinus node - sinus tachycardia, sick sinus syndrome
- Atria - atrial ectopics, atrial fibrillation, atrial flutter, atrial tachycardia
- AV node - AV block, junctional tachycardia
- Ventricle - ventricular ectopics, ventricular tachycardia
- Long QT syndrome
- Wolff-Parkinson-White Syndrome
Cardiac Structural
- Valvular disease - especially mitral valve prolapse
- Cardiomyopathy
- Congenital heart disease
- Autonomic dysfunction
Non-Cardiac
- Anxiety
- Exercise
- Alcohol
- Dehydration
- Anaemia
- Pregnancy
- Hypoglycaemia
- Hyperthyroidism
- Phaeochromocytoma
- Stimulants - caffeine, cocaine, amphetamines, pseudoephedrine
History of Presenting Complaint
Type of Palpitations
Whether the beats are fast, slow, irregular or heavy.- FastAtrial or ventricular tachyarrhythmia
- SlowAV block or sick sinus syndrome
- IrregularAtrial fibrillation, or atrial / ventricular ectopics
- Intermittent 'skipped' beatsAtrial or ventricular ectopics; may represent AV block
- Intermittent pounding beatsVentricular ectopic beats
Onset
When the palpitations started and what the patient was doing.- Post exerciseMay be physiologic due to dehydration, or suggestive of mitral valve prolapse
Timing
How long the patient has had palpitations, and how often they have these symptoms.- Palpitations since childhoodSuggestive of accessory pathway with AVRT
Associated Symptoms
Whether the pain is associated with any other symptoms.- Chest painMay suggest arrhythmia in the setting of ACS or PE
- Shortness of breathMay be due to tachyarrhythmia, anxiety or anaemia
- Tremor, sweating or heat intoleranceSuggestive of hyperthyroidism
- Feeling of anxietyMay be due to a panic attack or a result of arrhythmia
- Lightheadedness or syncopeMore likely to represent a sinister cause such as tachyarrhythmia
Alleviating Factors
Whether the palpations are improved or stop with rest, valsalva or water immersion- Relief with valsalva, carotid massage or water immersionSuggestive of SVT
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