Palpitations: When being aware of heart beating could be a concern

Some people die from arrhythmia without palpitation! Palpitations or the awareness of one’s own heartbeat is rarely sinister, but you need to know when to take it more seriously. The heartbeat is felt when there is increased force of contraction, through adrenergic drive or high stroke volume. It will also be felt with loss of elasticity when the kinetic energy of pulsatile flow is transmitted to the chest wall. medskl.com is a free, global medical education site (FOAMEd) covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations. Cardiology – Palpitations: What You Need to Know Whiteboard Animation Transcript with Jon Silberberg, MD aka Prof. Montage https://medskl.com/Module/Index/palpi... Palpitation means awareness of the heart beating. Most cases are benign, but it could mean a serious arrhythmia, so you need to recognize when to be concerned. Is it fast or slow? Regular or irregular? If slow and irregular, you’re most likely dealing with extra beats. The patient may feel an odd sensation in the throat, or the need to cough, even a little breathless, but there shouldn’t be symptoms of low output. In this setting, reassure the patient. Get an ECG (EKG) to confirm extra beats and leave it at that. Do they have underlying heart disease? This is the most important question. The arrhythmia you’re most worried about is ventricular tachycardia, or VT. VT is rapid and regular and usually brings low output symptoms. The patient may feel like passing out, or they may appear pale. They may even collapse without warning. This can cause sudden death and the people most at risk are those with abnormal pump function. Chest pain or breathlessness may be present but are not specific. Even with normal coronary vessels, a relative blood supply & demand imbalance may exist. Therefore, these symptoms don’t discriminate between ventricular tachycardia and less serious supraventricular rhythms, such as atrial fibrillation or atrial flutter. You should be able to recognize a typical vasovagal attack. This type of blackout is benign. There may be palpitation, but it is never rapid. There will always be some warning as sympathetic tone is withdrawn, usually lightheadedness with nausea. This is a time to reassure the patient rather than over-investigate. Other features of the history may give a clue to the type of arrythmia. Sudden onset and offset is typical of reentrant tachycardias such as atrial flutter or supraventricular tachycardia. Think of this arrhythmia like a light switch. Rapid irregular palpitation is most likely to be atrial fibrillation. Think of this arrhythmia like a sputtering car engine. Finally, you should investigate every potential arrhythmia with an ECG (EKG) as soon as possible, ideally when palpitation is present. This will allow you to correlate the recorded rhythm with symptoms.