Palpitations

Palpitations

by Putri Yasmin Ayesya Binti Sonari, undergraduate student, Faculty of Medicine, Universiti Teknologi MARA

Definition

The symptom “palpitations” refers to an increased awareness of the normal heart beat, or the sensation of a slow, rapid or irregular heart rhythm.

The patient may describe the symptom as the feeling of:
– Skipped heart beats
– Sudden thump
– Hard beating
– Fluttering in the chest
– Jittery sensation
– Rapid pulse
– Vague feeling of irregular heart beat

Comment. Palpitations may be more prominent at night when the patients lie on their left side.

Further questions that should be asked:

• intake of alchol and caffeine
• termination of palpitation

If palpitation starts abruptly, with sudden termination, this indicates the sudden reversal of a paroxysmal arrhythmia
If palpitation subsides gradually, this favors a diagnosis of sinus tachycardia

• associated symptoms: dizziness and syncope, dyspnoea
• family history: sudden cardiac death, cardiomyopathy

Causes of palpitations

Other possible causes causing palpitation

–         Metabolic disorder

• Hyperthyroidism
• Hypoglycaemia
• Hypo/hypercalcaemia
• Hypo/hypermagnesemia
• Phaeochromocytoma

–         High Cardiac Output

• Anaemia
• Pregnancy

Differentiating the common causes of palpitation

Pathogenesis

Investigating a patient who complains of palpitations

–         Full Blood Count

•  anemia
•  infection

–         Urea and electrolytes

• electrolyte Imbalance

–         TSH

•  thyroid dysfunction

–         Electrocardiogram

• Atrial fibrillation
• Right Ventricular Hypertrophy
• Left Ventricular Hypertrophy
• Prolonged QT interval
• Short PR interval

–         Cardiac Catheterization

• Coronary Artery Diseases