TAILIEUCHUNG - Chapter 037. Palpitations

Harrison's Internal Medicine Chapter 37. Palpitations Palpitations: Introduction Palpitations are extremely common among patients who present to their caregiver and can best be defined as an intermittent "thumping," "pounding," or "fluttering" sensation in the chest. This sensation can be either intermittent or sustained, and either regular or irregular. Most patients interpret palpitations as an unusual awareness of the heart beat and become especially concerned when they sense that they have had "skipped" or "missing" heart beats. Palpitations are often noted when the patient is quietly resting, during which time other stimuli are minimal. Palpitations that are positional may reflect. | Chapter 037. Palpitations Harrison s Internal Medicine Chapter 37. Palpitations Palpitations Introduction Palpitations are extremely common among patients who present to their caregiver and can best be defined as an intermittent thumping pounding or fluttering sensation in the chest. This sensation can be either intermittent or sustained and either regular or irregular. Most patients interpret palpitations as an unusual awareness of the heart beat and become especially concerned when they sense that they have had skipped or missing heart beats. Palpitations are often noted when the patient is quietly resting during which time other stimuli are minimal. Palpitations that are positional may reflect a structural process within . atrial myxoma or adjacent to . mediastinal mass the heart. Palpitations are brought about by cardiac 43 psychiatric 31 miscellaneous 10 and unknown 16 causes according to one large series. Cardiac causes include premature atrial and ventricular contractions supraventricular and ventricular arrhythmias mitral valve prolapse aortic regurgitation and atrial myxoma. Intermittent palpitations are commonly caused by premature atrial or ventricular contractions the postextrasystolic beat is sensed by the patient owing to the increase in ventricular end-diastolic dimension following the pause in the cardiac cycle and the increased strength of contraction postextrasystolic potentiation of that beat. Regular sustained palpitations can be caused by regular supraventricular and ventricular tachycardias Chap. 226 . Irregular sustained palpitations can be caused by atrial fibrillation. It is important to note that most arrhythmias are not associated with palpitations. In those that are it is often useful either to ask the patient to tap out the rhythm of the palpitations or to take his or her pulse while palpitations are occurring. In general hyperdynamic cardiovascular states caused by catecholaminergic stimulation from exercise stress or .

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