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 Post subject: PALPITATIONS
PostPosted: 07 May 2018 21:37 
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Joined: 19 Dec 2017 14:21
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What are Palpitations?
Normally, we are not aware of our heart beating within the chest cavity. Palpitation is an awareness of one’s own rapid, fluttering or irregular heartbeat. Most cases are harmless and shortlived. However, if they are severe and persistent, it may be necessary to seek medical attention.

Palpitations are variously described as ‘racing heart’, ‘fluttering or thumping sensation’ or ‘chest discomfort’. They can occur at any time, while resting, moving about and performing routine activities. It may be felt in the chest, neck or throat.

Overview of the Conducting System of the Heart
The conducting system of the heart is responsible for generating and transmitting the electrical impulse which is felt peripherally as the pulse. The normal pulse rate is 70 – 80 beats per minute and is described as regular sinus rhythm. The conducting system is described briefly below.

• The heart is made of four chambers, two upper chambers or the right and left atria and two lower chambers, the right and left ventricles

• The heart is made up of mostly muscle which contract to pump blood into the lungs for oxygenation and then into the major blood vessel, namely the aorta to be distributed to the entire body.

• In the right atrium is a group of cells called the sinoatrial or SA node which is the natural pacemaker of the heart. It auto-generates electrical impulses at a rate of about 60 – 80 beats per minute at rest

• This impulse is transmitted to every muscle cell of the atria so that they contract in sync to pump blood to the ventricles. This represents the first half of the heartbeat

• While the atria are pumping blood into the ventricles, an electrical impulse is sent to a structure called the atrioventricular or AV node situated at the junction of the atria and ventricles. The AV node delays the transmission of the electrical impulse from the atria to the ventricles by a fraction of a second to allow time for the ventricles to fill with blood before they begin to contract.

• Once the ventricles are filled, the impulse is transmitted to all muscle cells of the ventricle which contract in sync to pump blood to the body

Abnormalities in the conduction system may cause the heart to beat too rapidly, slowly or in an irregular fashion (arrhythmias).

Causes/Risk factors of Palpitations
In many cases, no cause can be found. Some common factors that places a person at an increased risk of suffering from palpitations include the following

• Strong emotions such as stress, anxiety or panic attacks
• Depression
• Vigorous exercise
• Stimulants such as caffeine, nicotine, cocaine, amphetamines, and cold and cough medications that contain pseudoephedrine
• Fever
• Hormonal imbalances associated with menstruation, pregnancy or menopause
• Too much or too little thyroid hormone
• Drugs such as beta blockers, thyroid medications, inhalers and decongestants

Occasionally heart palpitations can be a sign of a serious problem such as abnormal heart rhythm (arrhythmia). Arrhythmias might variously cause a very fast heart rate (tachycardia), an unusually slow heart rate (bradycardia) or an irregular heart rhythm.

Types of Rhythm Disturbances that May Cause Palpitations
• Premature atrial contractions
• Premature ventricular contractions
• Supraventricular tachycardia
• Atrial flutter and fibrillation
• Ventricular tachycardia and ventricular fibrillation

Palpitations and Associated Symptoms
The patient may describe palpitations in the following terms

• Rapid heart beat
• Fluttering sensation of heart
• Pounding of heart
• Missed beats
• Flip-flopping

Palpitations may indicate a more serious health problem if any of the following symptoms are associated. Seek immediate medical attention in their event

• Dizziness and feeling light headed
• Confusion
• Associated chest pain or discomfort
• Have trouble breathing
• Pass out while experiencing the palpitations

Complications of Palpitations
Usually complications will be seen only when palpitations are due to an underlying heart condition. Complications include

• Fainting attacks
• Stroke (in atrial fibrillation)
• Cardiac arrest (eg in ventricular fibrillation)
• Heart failure

Work-up in Palpitations
While working up a patient for palpitations, a detailed history and physical examination followed by additional tests will be performed

History – Description of the palpitations and when they occur, presence of associated symptoms, drug history, history of pre-existing heart or lung disease

Physical examination
– Measurement of pulse, blood pressure, auscultation of heart, examination of thyroid gland

Electrocardiogram (ECG) – Recording the ECG to check for presence of any rhythm disturbances or other abnormalities. The test may be done at rest or during exercise (stress ECG)

Blood tests – To rule out anemia, thyroid disorder, electrolyte levels

Echocardiogram – This is an ultrasound test of the heart and will demonstrate structural and functional abnormalities of the heart

Ambulatory ECG - This ECG test continuously monitors the heart over 24 or 48 hours while carrying out daily activities. The patient should record when the palpitations occur during this period so that the doctor can check the ECG to see if there are any changes when the palpitations are reported to have occurred by the patient

Electrophysiological studies – In this test, the electrical system of the heart is mapped out. It is similar to a heart catheterization, but the catheter is introduced into a vein instead of an artery. The long catheter and electrode is guided into the heart to assess the electrical activity inside the heart muscle. Sometimes abnormal foci may be found and treated by ablation or destroying the abnormal tissue eg Wolff Parkinson White (WPW) syndrome

Treatment of Palpitations
Treatment usually addresses the underlying cause of the palpitations.

Lifestyle Changes and Other Remedies - Most cases are harmless and lifestyle and other changes will be advised such as

• Cessation of smoking
• Reduce or avoid intake of alcohol, caffeine, over the counter herbal medications
• Avoid substances of abuse such as cocaine and amphetamine
• Management of stress and anxiety – meditation, yoga, biofeedback, deep breathing
• Avoiding activities that trigger palpitations
• Proper control of blood pressure and cholesterol

Medications – Depending on the cause drugs may be prescribed to control the rate and rhythm of the heart.

Surgery – Ablation of abnormal foci or other procedures may be performed to treat the cause of palpitations. Pacemakers may be inserted in some cases to restore normal rhythm or correct an underlying disorder


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