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Palpitations--Causes and DiagnosisSensations of Abnormal Heartbeat are Usually Benign
Palpitations-- those flutters or other odd sensations in the chest-- are common occurrences in daily life. They are usually benign, but they can indicate serious trouble.
Palpitations are the increased or abnormal awareness of one’s heartbeat, and they are a relatively common complaint for patients presenting to doctors’ offices. Palpitations can be caused by a variety of cardiac and non-cardiac problems. Most palpitations are caused by cardiac arrhythmias or anxiety, and most of them are benign. (Knudson MP. The natural history of palpitations in a family practice. J Fam Pract 1987;24:357-60). However, palpitations can be symptomatic of potentially life-threatening cardiac arrhythmias. Medical evaluation is recommended when palpitations are persistent or recurrent, when they are accompanied by dizziness, fainting or near-fainting, or when they are exacerbated by exercise. Causes of PalpitationsCardiac Arrhythmias
(Note: tachycardia=abnormally rapid heart rate; bradycardia=abnormally slow heart rate) Non-arrhythmic Cardiac Causes of Palpitations
Psychiatric Causes of Palpitations
Drugs and Medications that Cause Palpitations
Non-cardiac Causes of Palpitations
(Source: Am Fam Physician 2005;743-50) Diagnosis of PalpitationsAlthough palpitations can be frightening, people who have palpitations do not exhibit a higher mortality rate than those who don’t (Knudson). And, oddly enough, many people who have sustained potentially life-threatening cardiac arrhythmias do not report palpitations. A physician can often determine the underlying cause of palpitations through a careful history and physical examination. For example, the presence of a heart murmur might indicate valvular disease; a family history of sudden cardiac death would raise concerns. A resting electrocardiogram (ECG) is usually a part of the initial evaluation. In the majority of cases, patients’ palpitations are not occurring at the time of their doctor visits. So—depending on a patient’s history and clinical findings—further tests or monitoring might be necessary. Additional diagnostic workup might include blood tests to rule out anemia, thyroid disease, or electrolyte imbalance. ECG stress testing is usually recommended for patients who have cardiac risk factors. An echocardiogram (ultrasound of the heart) might be ordered to evaluate one’s heart valves or ventricular function. Finally, when it is appropriate, ambulatory cardiac monitoring may be performed. For individuals whose palpitations reliably occur on a daily basis, a Holter monitor, worn for 24 or 48 hours, is a reasonable way to analyze the heart’s rhythm. For those individuals whose palpitations occur less frequently, long-term, trans-telephonic event monitoring may reveal the cause. These monitors (some of which are worn continuously, while others are carried like a cell phone) are activated by the patient whenever the palpitations occur. The data are then relayed via telephone to a centralized station where they can be interpreted. Although the majority of palpitations are completely benign and need no treatment, an occasional patient may require medications, invasive electrophysiologic manipulation, or even surgery to address a dangerous arrhythmia.
The copyright of the article Palpitations--Causes and Diagnosis in Heart Disease Diagnosis is owned by Stephen Allen Christensen. Permission to republish Palpitations--Causes and Diagnosis in print or online must be granted by the author in writing.
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