palpitation心悸英语

Palpitation,Zhou YunThe Affiliated Hospital of Medical College of Ningbo UniversityEmergency Department,Objective,DefinitionEtiology and pathogenesisDifferential diagnosisDiagnosisManagement,Definition,Uncomfortable awareness of heart beat or undue awareness of heart action.Defined as thumping , pounding or fluttering sensation in the chest. Intermittent or Sustained Regular or Irregular,Etiology and Pathogenesis,Palpitation is due toAlteration in heart rateSinus tachycardia & BradycardiaAlteration in heart rhythmAtrial fibrillationAugmentation of myocardial contractionAnxiety states & Drugs,Causes of Palpitations,Cardiovascular Causes,ArrhythmiasPremature atrial and ventricular contractionsSupraventricular and ventricular arrhythmiasWPW (Wolff-Parkinson-White) syndromeAtrial fibrillationAtrial flutter with varying blockBrady-arrhythmias : complete heart blockSick-sinus syndrome,Cardiovascular Causes,Non-arrhythmic cardiac causesMitral valve prolapse (with or without associated arrhythmias)Aortic insufficiencyAtrial myxomaPulmonary embolismCongenital heart diseasesSystemic hypertensionPericarditisPacemaker induced tachycardia,Psychiatric Causes,Include Panic attacksAnxiety statesSomatization,Psychiatric Causes,Feature A longer duration of sensation 15min Multiplicity of symptoms Cardiac evaluation still may be necessary in patients with suspected panic disorder. Arrhythmic causes must be ruled out before the diagnosis of anxiety or panic disorder,Miscellaneous Causes,Hyperkinetic circulatory states :AnaemiaFever Thyrotoxicosis Hypoglycemia Phaeochromocytoma,Miscellaneous Causes,Drugs :Aminophylline Atropine Thyroxine Tricyclic antidepressants VasodilatorsDigitalis,Miscellaneous Causes,Others :CaffeineCocaine Amphetamines Tobacco Ethanol,Others,Spontaneous skeletal muscle contractions of the chest wallSystemic mastocytosisPhysiological causesExertion Excitement PregnancyNeurocirculatory astheniaVaso-vagal attack,APPROACH TO THE PATIENT WITH PALPITATIONS,“Principal goal in assessing patients with palpitations is to determine if the symptom is caused by a life threatening arrhythmia”,HOW TO EVALUATE PALPITATION,STEP 1Is palpitation continuous or intermittent ?Intermittent P. are commonly caused by premature atrial or ventricular contractionsVentricular end-diastolic dimensionPost-extrasystolic potentiation,HOW TO EVALUATE PALPITATION,STEP 2Is heart beat regular or irregular ?Regular, sustained palpitationsSVT(supraventricular tachycardia) and/or VT (ventricular tachycardia)Irregular, sustained palpitationsAtrial fibrillation,HOW TO EVALUATE PALPITATION,STEP 3 : What is the heart rate ?STEP 4 : Does palpitations occur in discrete attacks ?Is onset abrupt?What can terminate attacks?Ventricular arrhythmias are onset suddenlyHolding breath or vagal manoeuvres decrease palpitations in SVT,STEP 5Are there any associated symptoms ?Chest pain : Arrhythmogenic MI (myocardial infarction)Dyspnea : Heart failure due to arrhythmiasSyncope : Low cardiac output during arrhythmias, hypoglycemia, phaeochromocytomaSweating : Anxiety, hypoglycemiaDiarrhoea : Thyrotoxicosis,HOW TO EVALUATE PALPITATION,STEP 6 :Are there any precipitating factors ?Exercise Stress Alcohol intakeDrugsSTEP 7 :Is there a history of structural heart disease ?Coronary heart diseasesValvular heart diseases,HOW TO EVALUATE PALPITATION,Physical examination,Vital signsJugular venous pressure and pulseAuscultation of the chest and precordium,Examination,ECGResting ECGExercise ECG24-hour ECG,Examination,OthersHolterLoop recordings (external or implantable) Mobile cardiac outpatient telemetry.Event recorder,Examination,Holter monitor,Implantable loop recorders,Mobile cardiac outpatient telemetry,Management in a Nutshell,Re-assuranceLifestyle modificationCorrection of co-morbid diseasesAnxiolytics and