Approach to

the patient
with
PALPITATIONS

Dr. Gatot Sugiharto, SpPD

Department of Internal Medicine
Faculty of Medicine Wijaya Kusuma University Surabaya

Palpitations
Definition : An awareness of the beating
of the heart
Describe commonly as pounding, fluttering, stopping, missing, skipping, jumping,
racing, running away, flip flop beats
Usually benign, occasionally a manifestation of potentially life threatening
conditions

Palpitations

Causes of palpitations
Cardiac origin : arrhythmia, markedly
ventricle enlargement
Non cardiac origin : Thyrotoxicosis, hypoglycemia, pheochromocytoma, fever (increased catecholamine levels)
Drugs : tobacco, coffee, tea, alcohol, epinephrine, ephedrine, aminophilin, atropine
Psychiatric conditions (panic & depression)
Palpitations

Marieb EN, Human Anatomy

& Physiology,1999; 699

Palpitations

Mechanism
Change in the hearts rhythm, rate &/or
increase force of contraction
Increase of catecholamine (during exercise,
stress, panic, hypoglycemia, etc) with decrease
vagal tone
adrenergic stimulation hypersensitivity (young
female)
Hyperkinetic circulation (pregnancy, pheocromocytoma, hypertiroid)
Syncope decrease cardiac output, acute
vasodilatation
Palpitations

Approach to the patients

History taking: Onset, duration, associated
symptom & circumstance in which they occur

Abrupt onset, irregular & termination in several

minute VT / SVT
Gradual onset, regular, pounding heart sinus
tachycardia
Skipped, flopping beat atrial/ventricular extra
systole
Sustained bursts of rapid heart
ventricular/supraventricular tachyarrhythmia
Sustained irregular rhythm AF (hyperthyroid)
Slow rhythm AV block
Palpitations

Palpitations

Greene II HL, et all. Decision Making

in Medicine, 1998; 61

Physical examination
Goal Defining potential CV abnormalities
as a substrate for arrhythmias
Mid systolic click of MV prolapsed SVT/VT
Harsh holosystolic murmur on left sternal border
Obstructive hypertrophic cardiomyopathy
AF, rarely VT
Dilated cardiomyopathy, CHF VT, AF
Heart enlargement AI

Diagnostic testing :
The Holter monitor
Continuous-loop event recorder
Treadmill Exercise testing
Palpitations

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Palpitations

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