Palpitations

Definition -Disagreeable sensation of pulsation or movement in the chest and / or adjacent areas

How common -One of the most common complains for which patients seek help in primary careStudies quote different numbers - which vary from 15-20 % of presentations Account for significant cardiology out-patients work loadUp to 30-40 %2nd to chest painNo significant organic pathology in most cases Investigations can be expensive , time consuming and yet fail to establish a cause In patients presenting to a university medical center with palpitations 41 % has arrhythmic cause , 31 % had psychological disorder as anxiety and 16 % no cause was identified

Causes

Cardiac aetiologies can be

ventricular as premature ventricular contractions VT ventricular fibrillation

Atrial –Atrial fibrillation, flutter

High output state-Anaemia AV fistula Pagets disease Pregnancy

Structural- Congenital heart disease Cardiomegaly Aortic anurysm / stenosis Acute LVF

Miscellaneous -POTS ( postural orthostatic tachycardia synd ) Brugada syndrome Sinus tachycardia Ectopics

Psychosomatic -Anxiety and panic attacks Depression Somatization disorders

Systemic causes-Hyperthyroidism Hypoglycaemia Menopause Pregnancy Fever Anaemia Hypovolaemia Orthostatic hypotension Phaecochromocytoma

Drugs -Sympathomimetic agents Recent withdrawal of beta blockers Drugs that prolong the QT interval-Antifungals - eg itraconazole Alcohol , caffeine , nicotine , cocaine , amphetamines ,...