Chapter 52 - Palpitations Flashcards
Give examples of causes for positional palpiations.
Atrial myxoma and mediastinal masses.
Summarize the etiologic categories for palpiations as well as their respective prevalence.
Cardiac (43%)
Psychiatric (31%)
Idiopathic (16%)
Miscellaneous (10%)
What are the cardiac causes of palpiations?
“Among the cardiovasuclar causes are premature atrial and ventricular contractions, supraventricular and ventricular arrhythmias, mitral valve prolapse (with or without associated arrythmias), aortic insufficiency, atrial myxoma, and pulmonary embolism.”
Differentiate the etiologies of intermitent and sustained regular versus irregular palpitations.
“Intermittent palpitations are commonly caused by premature atrial and ventricular contractions: the post-extrasystolic beat is sensed by the patient owing to the increase in ventricular end-diastolic dimension following the pause in the cardiac cycle and the increased strenght of contraction (post-extrasystolic potentiation) of that beat). Regular, sustained palpitations ca be caused by regular supraventricular and ventricular tachycardias. Irregular, sustained palpitations can be caused by atrial fibrillation.”
Most arrhythmias are not associated with palpitations.
True or False?
True.
Palpitations are common among athletes.
True or False?
True, especially older endurance athletes.
Name drugs that indice palpitations due to increased strenght of myocardial contractions.
Tobacco, aminophiline, caffeine, thyroxine, amphetamines and cocaine.
Summarize the psychiatric causes associated with palpitations.
“Pschiatric causes of palpiations include panic attacks or disorders, anxiety states, and somatization, alone or in combination. Patients with psychiatric causes for palpiations more commonly report a longer duration of the sensation (>15 min) and other accompanying symptoms than do patients with other causes.”
Name the miscellaneous causes of palpitations.
Thyrotoxicoses, drugs (such as aminophiline, caffeine, thyroxine, amphetamines and cocaine), thoracic skeletal muscle spontaneous contractions, pheocromocytoma and systemic mastocytosis.
How should initially adress patients with palpitations?
“The principal goal in assessing patients with palpitations is to determine whether the symptom is caused by a life-threatening arrhytmia. Patients with preexisting coronary artery disease (CAD) or risk factors for CAD are at greatest risk for ventricular arrhythmias as a cause for palpitations. In addition, the association of palpitations with other symptoms suggesting hemodynamic compromise, including syncope or ligheadedness, spports this diagnosis.”
If exertion is knonwn to induce the arrhythmia and accompanying palpitations, exercice electrocardiography can be used to make the diagnosis.
True or False?
True.
Which electrocardiographic methods might be used to identify transient arrhythmias in the outpatient setting?
“Holter monitoring; telephonic monitoring, through which the patient can transmit an electrocardiographic tracing during a sensed episode; loop recordings (external or implantable), which can capture the electrocardiographic event for alter review; and mobile cardiac outpatient telemetry.”
Compare Holter to loop recorders.
Holter can be used if the arrhytmic events are frequent (>1 episode per week), while loop records are more adequate for rarer episodes, as an external device (>1 episode per month) or implantable (if episodes are rare).
Also, “Data suggests that Holter monitoring is of limited clinical utility, while the implantable loop recorder and mobile cardiac outpatient telemetry are safe and possible more cost-effective in the assessment of patients with (infrequent) recurrent, unexplained palpitations.”
