Palpitation

Palpitation is a patient's perception of the work of his heart. Patients describe it as fluttering, popping up or beating. For such cases, sinus rhythm with normal heart rate is usually uncharacteristic. Associated symptoms differ depending on the etiology.

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Cause of palpitations

Causes range from mild to life-threatening. Some patients simply feel a physiological increase in cardiac activity, for example, with exercise, increased body temperature, stressful situations, which increases the heart rate. In most cases, the palpitations felt are a consequence of arrhythmia.

The cause of sudden palpitation, the feeling that the heart beats with a very high frequency, and it seems, can "jump out" of the chest, are paroxysmal tachycardias. Heart failure is one of the causes of heart palpitations during exercise. Sometimes the palpitation may be associated with an increase in stroke volume, for example, in case of anemia or aortic insufficiency. Sensations of interruptions in the work of the heart are most often caused by extrasystoles - premature contractions of the heart. Less often the cause of interruptions in the work of the heart are atrial fibrillation or blockade of the heart.

Extrasystoles, many variants of tachycardia and heart block are often observed in completely healthy people in other respects. These are the so-called idiopathic cardiac arrhythmias. At such people at inspection it is not possible to reveal any disease of cardiovascular system and attributes of a lesion of a myocardium, except for presence of an arrhythmia. Idiopathic arrhythmias, as a rule, do not pose a danger to life. However, the occurrence of arrhythmia for the first time in life can be associated with an acute cardiovascular pathology, for example, with myocardial infarction.

It should be noted that different people have different sensitivity to the sensation of arrhythmias. Some patients do not have any unpleasant sensations even with severe arrhythmias, and the fact of the presence of a heart rhythm disturbance is revealed in them only at palpation of the pulse or when recording an electrocardiogram (ECG). Other patients feel every extrasystole, often these feelings are very unpleasant or even accompanied by fear ("sensitive heart").

The most frequent form of arrhythmias is premature contraction of the atria (atrial extrasystole - PES), / or ventricles (ventricular extrasystole - VES), which in most cases are not dangerous. Other arrhythmias include paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation and flutter, and ventricular tachycardia. Some irregularities in the rhythm (for example, PES, VES, PSVT) often occur spontaneously, without the presence of serious pathology in the patient, 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 a heartbeat. Often the development of heartbeats provokes the intake of certain substances, including caffeine, alcohol, sympathomimetics (epinephrine, ephedrine, theophylline). Anemia, hypoxia and electrolyte disturbances (for example, caused by taking diuretics hypokalemia) can provoke the appearance of a strong heartbeat.

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Heartbeat Diagnosis

Anamnesis. The form of the rhythm disturbance can be determined by the pulse or by auscultation (tachycardia, bradycardia, extrasystoles). The exact diagnosis is established by ECG. PES and VES are often described as single "pop-up" contractions of the heart; all other descriptions are atypical. Atrial fibrillation is defined as a constant irregular heart rate. Supraventricular and ventricular tachycardia are always described as a rapid rhythmic increase in the heart rate with sudden onset and termination. Often, such episodes are recorded in an anamnesis. It is often easier for a patient to tap a rhythm of the heartbeat than describe it in words.

It is necessary to ask the patient about the presence of weakness, dyspnea, dizziness and loss of consciousness, which may indicate the defeat of the coronary artery (CHD) or other serious heart disease. Prolonged malaise and weakness are signs of anemia or heart failure. Palpitation in patients with coronary artery disease can 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 ask questions about the use of caffeine, alcohol and other substances (for example, amphetamine, cocaine, other banned stimulants, anorectics, food additives).

Objective inspection. Palpation of the arterial pulse and auscultation of the heart can reveal frequent heart rhythm disturbances, with the exception of rare situations (the constant form of atrial flutter) with tachysystolic form of atrial fibrillation. The enlargement of the thyroid gland, the presence of exophthalmos testify to the use of thyrotoxicosis. An increase in blood pressure in combination with constant tachycardia can be a symptom of pheochromocytoma.

Additional research methods. Always appoint an ECG. Moreover, it should be remembered that an ECG performed against a background of absence of symptoms will most often not allow a diagnosis, since most arrhythmias are episodic. In conditions of separation of emergency therapy, the patient can be assigned to monitoring for 1-2 hours. In the event that the diagnosis is not specified, a 24-hour Holter monitoring should be applied. If episodes of arrhythmias are rare, you can use provocative tests.

If a serious illness is suspected, pulse oximetry is performed. Patients with a risk of electrolyte disturbances need to study the electrolyte composition of blood serum. With symptoms of anemia, the counting of blood cells is necessary. Patients with newly diagnosed atrial fibrillation have been shown to study the functions of the thyroid gland.

Treatment of palpitations

With an isolated PES or VES it is often enough to calm the patient. The detected rhythm disturbances and the diseases that lead to them require specific treatment. Drugs that increase the heart rate, cancel or replace with others.