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Symptoms
 
 

Palpitations

 
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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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