Palpitasi

Definisi Palpitasi
Palpitations are a symptom defined as awareness of the heartbeat and

are described by patients as a disagreeable sensation of pulsation or

movement in the chest and/or adjacent areas.

During or immediately after intense physical activity or emotional stress, it

may be quite normal to become aware of one’s own heartbeat for brief
periods -> physiological palpitations -> response to a certain challenge or
activity leading to an increase in the frequency and strength of the
contraction of the heart.
Outside of such situations -> palpitations are perceived as abnormal.
Penyebab palpitasi
Cardiac arrhythmias
Supraventricular/ventricular extrasystoles
Supraventricular/ventricular tachycardias
Bradyarrhythmias: Severe sinus bradycardia, sinus
pauses, second and third=degree atrioventricular
block
Anomalies in the functioning and/or programming of
pacemakers and ICDs
Penyebab palpitasi
Structural heart disease
Mitral valve prolapse
Severe mitral regurgitation
Severe aortic regurgitation
Congenital heart diseases with significant shunt
Cardiomegaly and/or heart failure of various
aetiologies
Hyperthropic cardiomyopathy
Mechanical prosthetic valves
Penyebab palpitasi
Psychosomatic disorders
Anxiety, panic attacks
Depression, somatization disorders

Systemic causes
Hyperthyroidism, hypoglycaemia, postmenopausal syndrome,
fever, anaemia, pregnancy, hypovolaemia, orthostatic
hypotension, postural orthostatic tachycardia syndrome,
phechromocytoma, arteriovenous fistula
Penyebab palpitasi
Effects of medical and recreational drugs
Sympathicomimetic agents inm pump inhalers,
vasodilators, anticholinergics, hydralazine
Recent withdrawal of B-blockers
Alcohol, cocaine, heroin, amphetmaines, caffeine,
nicotine, cannabis, synthetic drugs
Weight reductions drugs
Jenis palpitasi dan klinisnya
Jenis palpitasi dan klinisnya
Gejala dan kondisi yang sering
berhubungan dengan palpitasi
Palpitations arising after sudden changes in posture ->
intolerance to orthostatis or to episodes of
atrioventricular nodal reentrant tachycardia
Syncope or other symptoms, such as severe fatigue,
dyspnoea, or angina, in addition to palpitations ->
structural heart disease
Syncope may also occur at the onset of
supraventricular tachycardia in patients with a normal
heart -> triggering of a vasovagal reaction
Gejala dan kondisi yang sering berhubungan
dengan palpitasi
The sensation of a rapid, regular pulse in the neck
(usually associated with the ‘frog sign’) raises suspicion
-> supraventricular tachycardia, particularly
atrioventricular nodal reentrant tachycardia.
Polyuria, is typical of atrial tachyarrhythmias,
particularly atrial fibrillation.
Epidemiologi
In primary care settings, palpitations account for
16% of the symptoms that prompt patients to visit
their general practitioner, and are second only to
chest pain as the presenting complaint for specialist
cardiologic evaluation
Epidemiologi
Prospective study by Weber and Kapoor in 190 patients of
palpitations at an university medical centre:
Palpitations were due to arrhythmias in 41% of these patients
(16% of whom had atrial fibrillation/flutter, 10% had
supraventricular tachycardia, and 2% had ventricular
tachycardia),
Structural heart disease in 3%
Psychosomatic disorders in 31% (mainly panic and anxiety
disorders),
Systemic causes in 4%,
The use of a medication, illicit substances, or stimulants in
6%.
Epidemiologi
In the literature, there are insufficient data about the
age and gender distribution of palpitations.
In general, however, older patients and men are
more likely to have an arrhythmic cause of
palpitations and younger patients and women a
psychosomatic cause
• Gejala yang diceritakan pasien
berkaitan dengan palpitasi,
bukan dengan nyeri dada atau
kondisi non-palpitasi lainnya
• Keterangan dari anggota
keluarga yang menyaksikan
eposoden palpitasi dapat
membantu
• Pasien dapat dimintakan untuk
menirukan irama jantung yang
dirasakannya, misalnya
dengan mulut, atau dengan
derap jari tangan di meja
Risk Assessment pasien dengan palpitasi
Diagnostic flow-chart pasien dengan palpitasi
Temuan EKG pada pasien dengan palpitasi
yang akibat aritmia
Prognosis
The prognostic implications of palpitations are
dependent on the underlying aetiology as well as
clinical characteristics of the patient.
Although palpitations are generally associated with
low rates of mortality,4,47 they should bring to
attention a potential serious condition in patients with
structural or arrhythmogenic heart disease or a
family history of sudden death.
Prognosis
low mortality rate, very frequent recurrence of
symptoms
Frequent and recurrent palpitations -> impair the
patient’s quality of life, giving rise to anxiety and
frequent visits to the emergency department.
Daftar Pustaka
Raviele A, Giada F, Bergfeldt L, Blanc J, Lundqvist
C, Mont L, et al. Management of patients with
palpitations: a position paper from the European
Heart Rhythm Association. ESC; 2011. p.921-33.
doi:10.1093/europace/eur130