Heartbeat

Palpitations are the patient's perception of the heart's activity. Patients describe them as fluttering, jumping, or pounding. Sinus rhythm with a normal heart rate is not typical for such cases. Associated symptoms vary depending on the etiology.

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Cause of heart palpitations

Causes range from mild to life-threatening. Some patients simply experience a physiological increase in heart activity, such as when exercising, when the body temperature rises, or when stressed, which increases the heart rate. In most cases, the palpitations felt are due to arrhythmia.

The cause of sudden palpitations, the feeling that the heart is beating at a very high frequency and seems to be able to "jump out" of the chest, are paroxysmal tachycardias. One of the causes of palpitations during exertion is heart failure. Sometimes the sensation of palpitations can be associated with an increase in stroke volume, for example, with anemia or aortic insufficiency. The sensation of interruptions in the work of the heart is most often caused by extrasystoles - premature contractions of the heart. Less often, the cause of interruptions in the work of the heart is atrial fibrillation or heart block.

Extrasystoles, many types of tachycardia and heart blocks are often observed in otherwise healthy people. These are the so-called idiopathic heart rhythm disorders. In such people, examination does not reveal any cardiovascular disease or signs of myocardial damage, except for the presence of arrhythmia. Idiopathic arrhythmias, as a rule, do not pose a danger to life. However, the occurrence of arrhythmia for the first time in life may be associated with acute cardiovascular pathology, such as myocardial infarction.

It should be noted that different people have different sensitivity to the sensation of arrhythmia. Some patients do not experience any unpleasant sensations even with pronounced arrhythmias, and the fact of the presence of a heart rhythm disorder is revealed only by palpating the pulse or recording an electrocardiogram (ECG). Other patients feel every extrasystole, often these sensations are very unpleasant or even accompanied by fear ("sensitive heart").

The most common type of arrhythmia is premature contraction of the atria (atrial extrasystole - PES) and/or ventricles (ventricular extrasystole - PVC), which in most cases are harmless. Other arrhythmias include paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation and flutter, and ventricular tachycardia. Some rhythm disturbances (e.g. PES, PVC, PSVT) often occur spontaneously, without the presence of serious pathology in the patient, while others usually indicate a serious heart disease - myocardial ischemia, heart defects, or lesions of the conduction system. Diseases that lead to increased myocardial contractility (such as thyrotoxicosis, pheochromocytoma) can cause palpitations. The development of palpitations is often provoked by the intake of certain substances, including caffeine, alcohol, sympathomimetics (epinephrine, ephedrine, theophylline). Anemia, hypoxia and electrolyte disturbances (for example, hypokalemia caused by taking diuretics) can provoke the appearance of strong palpitations.

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Heartbeat diagnostics

History. The type of rhythm disturbance can be determined by the pulse or by auscultation (tachycardia, bradycardia, extrasystoles). The exact diagnosis is established by ECG. PES and VES are often described as single “jumping” contractions of the heart; all other descriptions are atypical. Atrial fibrillation is defined as a constant irregularity of heart contractions. Supraventricular and ventricular tachycardia are always described as a rapid rhythmic increase in heart rate with an abrupt onset and end. Such episodes are often noted in the anamnesis. It is often easier for a patient to tap out the rhythm of the heartbeat than to describe it in words.

It is necessary to ask the patient about weakness, shortness of breath, dizziness and loss of consciousness, which may indicate coronary artery disease (CAD) or another serious disease causing palpitations. Long-term malaise and weakness are signs of anemia or heart failure. Palpitations in patients with coronary vascular pathology may be accompanied by the appearance of ischemic chest pain associated with a decrease in coronary blood flow during tachycardia or bradycardia.

The patient should also be asked about the use of caffeine, alcohol, and other substances (eg, amphetamine, cocaine, other illicit stimulants, anorectics, dietary supplements).

Objective examination. Palpation of the arterial pulse and auscultation of the heart allow to detect frequently occurring disturbances of the heart rhythm, with the exception of rare situations (permanent form of atrial flutter) in the tachystolic form of atrial fibrillation. Enlargement of the thyroid gland, presence of exophthalmos indicate thyrotoxicosis. Increased blood pressure in combination with constant tachycardia can be a symptom of pheochromocytoma.

Additional research methods. An ECG is always prescribed. It should be remembered that an ECG performed in the absence of symptoms will most often not allow a diagnosis to be made, since most arrhythmias are episodic. In the emergency department, the patient can be prescribed monitoring for 1-2 hours. If the diagnosis is not clarified, 24-hour Holter monitoring should be used. If arrhythmia episodes occur rarely, provocative tests can be used.

If a serious disease is suspected, pulse oximetry is performed. In patients at risk of electrolyte disturbances, it is necessary to study the electrolyte composition of the blood serum. In case of symptoms of anemia, it is necessary to count the formed elements of the blood. Patients with newly diagnosed atrial fibrillation are recommended to study the functions of the thyroid gland.

Treatment of palpitations

In isolated PES or VES, it is often enough to simply calm the patient. The detected rhythm disturbances and the diseases that led to them require specific treatment. Drugs that increase the heart rate are discontinued or replaced with others.