{"id":1851,"date":"2021-06-08T11:13:25","date_gmt":"2021-06-08T08:13:25","guid":{"rendered":"https:\/\/nicosiacardiologypractice.cy\/diaxeirisi-asthenwn-me-aisthima-palmwn\/"},"modified":"2021-06-08T11:23:47","modified_gmt":"2021-06-08T08:23:47","slug":"management-of-patients-with-palpitations","status":"publish","type":"post","link":"https:\/\/nicosiacardiologypractice.cy\/en\/management-of-patients-with-palpitations\/","title":{"rendered":"Management of patients with palpitations"},"content":{"rendered":"\t\t
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The awareness of an abnormal heart rhythm is the definition of palpitations. It is one of the most common causes requiring a visit to the personal doctor (16%) and the second most common symptom after chest pain, that requires evaluation from a cardiologist. Patients describe the sensation in a variety of ways such as loss of a heartbeat, increased heart rate, sudden stop of the heart or “fluttering” in the chest area. This discomfort can also be felt in the neck or ear, especially during bedtime and is usually short-lived. It should be noted that normal heartbeat is perceived during intense physical activity or emotional stress. Although it is a very common phenomenon, little is known about the neurological mechanisms responsible for sensing the change in the heartbeat. It is possible that specialized receptors in the myocardium and pericardium recognize the change in rhythm and send the corresponding messages to higher brain centers for processing.<\/p>

Causes<\/strong><\/span><\/p>

The causes of palpitations can be divided into five major categories as presented in the latest guidelines of the European Society of Cardiology Categories:<\/p>

1. Cardiac Arrhythmias<\/strong><\/p>

i. Supraventricular \/ ventricular extrasystoles<\/p>

ii. Supraventricular \/ ventricular tachycardias<\/p>

iii. Bradyarrhythmias<\/p>

iv. Pacemaker malfunction<\/p>

2. Structural Heart Diseases<\/strong><\/p>

i. Prolapse of the mitral valve<\/p>

ii. Severe mitral valve regurgitation<\/p>

iii. Severe aortic valve regurgitation<\/p>

iv. Congenital heart disease<\/p>

v. Hypertrophic cardiomyopathy<\/p>

vi. Mechanical prosthetic valves<\/p>

3. Psychosomatic Disorders<\/strong><\/p>

i. Anxiety, panic attacks<\/p>

ii. Depression<\/p>

4. Systemic Diseases<\/strong><\/p>

i. hyperthyroidism<\/p>

ii. hypoglycemia<\/p>

iii. fever<\/p>

iv. anemia<\/p>

v. pregnancy<\/p>

vi. hypovolemia, orthostatic hypotension,<\/p>

vii. orthostatic tachycardia syndrome<\/p>

viii. pheochromocytoma,<\/p>

ix. arteriovenous communication<\/p>

\u00a0<\/p>

5. Effects of drugs and illicit substances<\/strong><\/p>

i. Sympathomimetic agents<\/p>

ii. Vasodilators and anticholinergics<\/p>

iii. Abrupt withdrawal of b-blockers<\/p>

iv. Alcohol, cocaine, heroin, amphetamines, caffeine, nicotine, cannabis,<\/p>

v. Weight loss drugs<\/p>

\u00a0<\/p>

Clinical presentation<\/strong><\/span><\/p>

The clinical presentation is diverse. Important information that the doctor must recognize is:<\/p>

\u2022 The rhythm<\/p>

\u2022 How the symptoms start and terminate<\/p>

\u2022 The triggering causes<\/p>

\u2022 How the patient perceives it<\/p>

\u2022 The accompanying symptoms.<\/p>

\u00a0<\/p>

For example, extrasystoles are arrhythmic, start abruptly, usually occur at rest, and the patient experiences an extra heartbeat without any other symptoms. In contrast, the palpitations due to emotional stress, have normal rhythm with gradual onset, occur after emotional stress and the patient emphasizes more on the feeling of anxiety rather than the change in cardiac function, describing symptoms such tingling of the upper extremities or mouth. , atypical chest pain and shortness of breath.<\/p>

In addition, palpitations after sudden changes in posture are often due to orthostatic hypotension or episodes of atrioventricular tachycardia. Arrhythmias that occur during exercise usually involve either monomorphic ventricular tachycardia or polymorphic catecholamine ventricular arrhythmia and require immediate investigation and treatment.<\/p>

It is important to know that severe symptoms such as fatigue, angina or even syncope usually affect patients with ischemic or other cardiomyopathies. We must emphasize that syncope can occur rarely and in people with a structurally normal heart during supraventricular tachycardia.<\/p>

Diagnostic approach<\/strong><\/span><\/p>

Obtaining a detailed history along with physical examination and electrocardiogram remain the cornerstone in the initial treatment of patients with palpitations. An individual history of ischemic cardiomyopathy, abnormal electrocardiogram findings (long QT syndrome, Brugada syndrome, left ventricular hypertrophy), and a family history of sudden cardiac death increase the chances that the palpitations are derived due to malignant arrhythmias.<\/p>

In patients at low or moderate risk for arrhythmia but with frequent episodes of palpitations, a heart rate Holter \u00a0placement can be performed for 24 hours to 7 days. This device is the size of a small mobile phone, is worn in a special case like a belt and the patient is asked to record a short diary of the time and the characteristics of the symptoms. Blood tests are usually necessary to rule out systemic diseases such as thyroid disease or anemia.<\/p>

Cardiac ultrasound as well as other modern non-invasive techniques such as computed tomography of the heart and blood vessels and magnetic resonance imaging are important tools in the hands of the cardiologist to make the diagnosis and plan the correct and timely treatment of the patient.<\/p>

Specialized examinations such as implantation of an implantable loop recorder (ILR) and invasive electrophysiological study are necessary in high-risk patients, with high clinical suspicion of the presence of severe arrhythmias but without having been recorded so far by other monitoring devices.<\/p>

\u00a0<\/p>

Therapeutic options<\/strong><\/span><\/p>

In the vast majority of patients with palpitations, the cause is benign and does not require extensive investigation or any specialized treatment. Reassuring the patient, avoiding the provocative causes and addressing the common risk factor is enough.<\/p>

Lifestyle changes should be made, such as reducing caffeine, quitting smoking and avoiding alcohol consumption. Healthy eating, exercise and reducing stress are very important as well.<\/p>

In special cases, antiarrhythmic drugs may be given to control symptoms such as \u03b2-blockers and calcium channel blockers. When the palpitations are due to severe and drug-resistant arrhythmias, catheter ablation is indicated and, if necessary, the placement of a pacemaker and \/ or an automatic implantable defibrillator.<\/p>

\u00a0<\/p>

References:<\/strong><\/span><\/p>

1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raviele, A., Giada et al (2011). Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace, 13(7), pp.920-934.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

The awareness of an abnormal heart rhythm is the definition of palpitations. It is one of the most common causes requiring a visit to the personal doctor (16%) and the second most common symptom after chest pain, that requires evaluation from a cardiologist. Patients describe the sensation in a variety of ways such as loss […]<\/p>\n","protected":false},"author":3,"featured_media":1845,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9,10,11,12],"tags":[],"class_list":["post-1851","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-arrhythmias","category-cardiomyopathy","category-cardiovascular-disease-risk-factors","category-valvular-heart-disease"],"yoast_head":"\nManagement of patients with palpitations<\/title>\n<meta name=\"description\" content=\"The awareness of an abnormal heart rhythm is the definition of palpitations. 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