The Investigation of the Patient with Palpitations
Palpitations, the uncomfortable awareness of a beating heart, are a frequent phenomenon which can occur under normal or abnormal circumstances. The heart beat can be felt in situations such as exercise, emotions, stress, or after ingesting, inhaling or receiving substances or medications which increase the adrenergic tone or diminish vagal activity (coffee, nicotine, adrenergic or anticholinergic drugs) . These are “normal” palpitations. There are also “abnormal” palpitations. The heart beat becomes fast, or strong and slow, or feels like a missed or extra heart beat without any apparent cause. “Abnormal” palpitations may point to a cardiac arrhythmia, but that is not always the case. Cardiac arrhythmias can cause other symptoms (syncope, shock, fair, chest pain) or sudden death and no palpitations at all. We will discuss here the approach to the patient who seeks medical attention because of a history of palpitations.
KeywordsIschemia Nicotine Stratification Cardiomyopathy Cardiol
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