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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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Associated Diseases
BETA

Cardiovascular
Arrhythmias
Narrow Complex Tachyarrhythmias
Structural Heart Disease
Cardiomyopathy
Vascular Disease
Drug and Alcohol
Endocrinology
Haematology
Nutritional Anaemias
Aplastic Anaemia
Haemolytic Anaemias
Other
Other
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