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A CLINICAL APPRAISAL @ 2 0 1 2
@ dr navojit chowdhury
Patients may use a variety of terms to describe their awareness of the heart beat (palpitations).
palpitation may be due , (1) rhythm disturbance ,or (2) subjective awareness of normal sinus rhythm
This can be described as skipped beats, a sudden thump, hard beating, fluttering in the chest, a jittery sensation, a rapid pulse, or a vague feeling of irregular heart rate.
A premature atrial or ventricular complex is not felt by the patient, it is the strong heartbeat that follows the pause.
Palpitations may be more prominent at night, especially when patients lie on their left side.
Diagnosis
History A rapid regular rhythm that occurs a few times, per year for many years is likely a form of PSVT. Tapping by the patient, may be helpful, to distinguish between atrial fibrillation (AF) and PSVT. Alcohol and caffeine play a minor role in patients who have arrhythmias particularly AF but not VT and PSVT.
1)It is particularly important to ask about termination of palpitation 2) By definition ,all palpitation starts abruptly
4)Where as, the palpitation that subsides gradually is usually sinus tachycardia that subsided gradually
Family history
Cardiomyopathy
long QT-syndrome
CAUSES OF PALPITITION
Cardiac 43%
Arrhythmia (40%)
Paroxysmal AF, SVT, supraventricular contractions , Multifocal atrial tachycardia ,WPW syn, Sick Sinus Syndrome ,Sinus tachycardia ,PVC VT
MVP, Valvular heart disease(AS, AI) . Atrial myxoma , Pacemaker-mediated tachycardia , CHF ,Congenital heart disease : Atrial septal defect, Patent ductus arteriosus , Ventricular septal defect , Pericarditis , Cardimyopathy,Aortic aneurysm . @dr navojit,nicvd,dhaka,2012
Psychiatric 43%
Drugs or medication 6%
Alcohol Amphetamines Anticolinergic B-blockers Caffeine Cocaine Epinephrine Digitalis Theophylline Vasodilators (Nitrates)
Lab investigations
To rule out , anemia and infection (complete blood count), electrolyte imbalance thyroid dysfunction (TSH) toxicology screening as guided by clinical suspicion
Investigations
Electrocardiogram can diagnose:
Prior Myocardial Infarction Left Ventricular Hypertrophy Right Ventricular Hypertrophy Atrial Fibrillation Atrial enlargement AV nodal block Prolonged QT Interval (QTc >460 in men, QTc >440 in men) Delta Waves Wolff-Parkinson-White Syndrome Short PR interval AV Nodal reentry rhythm
Electrophysiologic Study
Syncope, Life threatening arrhythmia suspected WPWsyn
future directions MCOT. unique new technology using wireless outpatient continuous monitoring can identify asymptomatic arrhythmic episodes and transmit ECG data .
Real-time data analysis and surveillance of the transmitted information by a technician. Mobile cardiac outpatient telemetry , (MCOT, CardioNet div. Sun Diego.CA, 2009). These devices are used to record suspected asymptomatic arrhythmias, studies suggest that mobile cardiac outpatient telemetry (MCOT) provides more effective detection of infrequent cardiac arrhythmias than external loop monitor.
https://www.oxhp.com/secure/policy/real_time_cardiac_surveillance_1211.html
@dr navojit,nicvd,dhaka,2012
End note
Even if sinus rhythm is identified as the cause of palpitations, the results are very valuable to the patient.
@dr navojit,nicvd,dhaka,2012