Palpitation represents the patient’s sensation of the work of his heart. Patients describe it as fluttering, jumping, or beating. For such cases, sinus rhythm with a normal heart rate is usually uncharacteristic. Associated symptoms vary depending on the etiology.
Cause of heart palpitations
Causes range from mild to life-threatening. Some patients simply experience a physiological increase in cardiac activity, for example, during exercise, increased body temperature, or stressful situations, which increases the heart rate. In most cases, palpitations are felt as a result of an arrhythmia.
The cause of sudden palpitations, the feeling that the heart is beating at a very high frequency and seems to be able to “jump out” of the chest, is paroxysmal tachycardia. One of the causes of palpitations during exercise is heart failure. Sometimes the feeling of palpitations can be associated with an increase in stroke volume, for example, with anemia or aortic regurgitation. Feelings of interruptions in the work of the heart are most often caused by extrasystoles – premature contractions of the heart. Less commonly, heart failure is caused by atrial fibrillation or heart block.
Extrasystoles, many variants of tachycardia and heart block are often observed in otherwise completely healthy people. These are so-called idiopathic heart rhythm disorders. In such people, examination fails to identify any disease of the cardiovascular system and signs of myocardial damage, except for the presence of arrhythmia. Idiopathic arrhythmias are usually not life-threatening. However, the occurrence of arrhythmia for the first time in life may be associated with acute cardiovascular pathology, for example, myocardial infarction.
It should be noted that different people have different sensitivity to the sensation of arrhythmias. Some patients do not experience any unpleasant sensations even with severe arrhythmias, and the presence of a heart rhythm disturbance is revealed in them only by palpation of the pulse or by recording an electrocardiogram (ECG). Other patients feel every extrasystole, often these sensations are very unpleasant or even accompanied by fear (“sensitive heart”).
The most common type of arrhythmias is premature contraction of the atria (atrial extrasystole – PES), / or ventricles (ventricular extrasystole – VES), which in most cases are harmless. Other arrhythmias include paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation and flutter, and ventricular tachycardia. Some rhythm disturbances (for example, PES, PVC, PSVT) often occur spontaneously, without the patient having a serious pathology, while others usually indicate a serious heart disease – myocardial ischemia, heart defects or lesions of the conduction system. Diseases that lead to increased myocardial contractility (such as thyrotoxicosis, pheochromocytoma) can cause palpitations. Often the development of palpitations is provoked by the intake of certain substances, including caffeine, alcohol, sympathomimetics (epinephrine, ephedrine, theophylline). Anemia, hypoxia, and electrolyte disturbances (eg, diuretic-induced hypokalemia) can cause palpitations.
Heartbeat Diagnostics
Anamnesis. The form of rhythm disturbance can be determined by pulse or auscultation (tachycardia, bradycardia, extrasystoles). An accurate diagnosis is made using an ECG. The RPE and VES are often described as single “popping” heartbeats; all other descriptions are atypical. Atrial fibrillation is defined as a persistent irregular heartbeat. Supraventricular and ventricular tachycardia are always described as a rapid rhythmic increase in heart rate with a sudden onset and end. Similar episodes are often noted in the anamnesis. It is often easier for a patient to tap the rhythm of the heartbeat than to describe it in words.
It is necessary to ask the patient about the presence of weakness, shortness of breath, dizziness and loss of consciousness, which may indicate damage to the coronary arteries (CAD) or another serious disease that causes palpitations. Prolonged malaise and weakness are signs of anemia or heart failure. Palpitations in patients with pathology of the coronary vessels may be accompanied by the appearance of ischemic pain in the chest associated with a decrease in coronary blood flow during tachycardia or bradycardia.
The patient should also be asked about the use of caffeine, alcohol, and other substances (eg, amphetamine, cocaine, other illicit stimulants, anorectics, dietary supplements).
Objective examination. Palpation of the arterial pulse and auscultation of the heart can identify common heart rhythm disturbances, with the exception of rare situations (a permanent form of atrial flutter) with the tachysystolic form of atrial fibrillation. An enlarged thyroid gland and the presence of exophthalmos indicate thyrotoxicosis. Increased blood pressure in combination with persistent tachycardia may be a symptom of pheochromocytoma.
Additional research methods. An ECG is always prescribed. Moreover, it should be remembered that an ECG performed in the absence of symptoms most often will not allow establishing a diagnosis, since most arrhythmias are episodic in nature. In an emergency department, the patient can be monitored for 1-2 hours. If the diagnosis is not clarified, 24-hour Holter monitoring should be used. If episodes of arrhythmias occur rarely, provoking tests can be used.
If a serious illness is suspected, pulse oximetry is performed. In patients at risk of having electrolyte disturbances, it is necessary to study the electrolyte composition of the blood serum. If symptoms of anemia occur, a blood cell count is necessary. Patients with newly diagnosed atrial fibrillation are advised to study the functions of the thyroid gland.
Treatment of palpitations
With isolated PES or PVC, it is often enough to simply reassure the patient. Identified rhythm disturbances and the diseases leading to them require specific treatment. Drugs that increase heart rate are discontinued or replaced with others.