Heart Palpitation

A definition of a heart palpitation describes a person's awareness of the beating heart-–pounding, fluttering–-due to changes in heart rate or rhythm or by increased force of contractions.

Palpitations are usually benign.

Description:

  1. Flip-flopping in chest – may be due to atrial premature contractions.

  2. Rapid fluttering in chest - may be due to sinus tachycardia or atrial or ventricular arrhythmias.

  3. Pounding in the neck – may be due to dissociation of atrial and ventricular contractions

Circumstances:

  1. Palpitation associated with Anxiety and Panic Reactions – last diagnosis after others ruled out.

  2. Palpitations during Periods of Catecholamine Excess – seen during exercise or during emotionally startling experiences.

  3. Palpitations associated with Position – standing or in bed.

  4. Palpitations associated with Syncope or Near-syncope – can occur with ventricular tachycardias.

Diagnostic Evaluation – need detailed history, physical examination and a 12-lead EKG.

  • Onset in childhood – supraventricular tachycardia like Wolff-Parkinson-White Syndrome (WPW)

  • Rate and degree of regularity of palpitations – rapid and regular suggest supraventricular or ventricular tachycardias and rapid and irregular suggest atrial fibrillation.

  • Mode of onset and termination – if abrupt consider supraventricular or ventricular tachycardias and if patient uses carotid massage or a Valsalva maneuver to terminate palpitations consider supraventricular tachycardias such as WPW

Physical Examination can define potential cardiovascular abnormalities that could be substrates for arrhythmias e.g. mitral valve prolapse has a mid-systolic click – supraventricular and ventricular tachycardias, hypertrophic obstructive cardiomyopathy – atrial fibrillation.

  • 12-Lead EKG can narrow the differential diagnosis of palpitations.



Return to Causes of Chest Pain

Return from Heart Palpitation to Medical Exam Essentials homepage

Don’t Miss
A Primer in Adult
Physical Diagnosis

With a 30-Day Money Back Guarantee, there is no risk involved in trying this handy new eBook.

Download the PDF now and start mastering the skills necessary for Physical Diagnosis.


Sign up for Periodic Site Updates

Add your name and e-mail address, and we’ll send you periodic site updates when we add other valuable documents for Medical Students.