Palpitations

Question 1

Worrying associated symptoms:

Answer 1

§ Chest discomfort or pain
§ Fainting
§ Severe shortness of breath
§ Severe dizziness
§ Not provoked by exercise.

Question 2

Common causes

Answer 2

strenuous exercise
lack of sleep
stress and anxiety
medicines e.g. Recent withdrawal of beta-blockers.
alcohol, caffeine, nicotine and recreational drugs
Sometimes heart palpitations can be a sign you’re going through the menopause. Some people get them during pregnancy.

Question 3

If palpitations are present initial

Answer 3

Check for murmurs suggestive of valvular disease.
Assess for signs of heart failure, such as raised jugular venous pressure (JVP), lung crepitations, and peripheral oedema.

Question 4

AF

Answer 4

A fast, irregular heart rhythm caused by uncoordinated electrical signals in the atria, leading to ineffective contraction. Abnormal impulses, often near the pulmonary veins, override the heart’s normal rhythm control. Electrical changes in heart cells may also contribute.

AF accounts for 20–30% of all ischaemic strokes and 10% of cryptogenic strokes. AF increases the risk of stroke five-fold, depending on the presence of additional risk factors.

Question 5

Types of AF

Answer 5

Paroxysmal — episodes lasting longer than 30 seconds that terminate spontaneously or with intervention within 7 days of onset (often within 48 hours).
Persistent — episodes lasting longer than 7 days, including episodes terminated by cardioversion (drug or electrical) after 7 days or more.
Longstanding persistent — continuous AF for at least 12 months duration and in combination with a rhythm control strategy.
Permanent — AF that is accepted by the patient and clinician, and no further attempts to restore or maintain sinus rhythm are planned.

Question 6

AF causes and risk factors

Answer 6

Hypertension — this is the most common risk factor associated with the development of AF. People with hypertension have a 1.7-fold higher risk of developing AF compared with people with blood pressure in the normal range.
Ischaemic heart disease.
Valvular heart disease.
Cardiomyopathy.
Pre-excitation syndromes — such as Wolff–Parkinson–White syndrome.
Sick sinus syndrome.
Congenital heart disease.
Inflammatory or infiltrative disease — such as pericarditis, amyloidosis, or myocarditis.
Recent cardiothoracic or other surgery.
DM
COPD
CKD
Increasing age.
Alcohol excess
Obesity
Smoking.
Medications such as thyroxine, lithium, or beta-2 agonist bronchodilators.