Palpitations Flashcards
What is a palpitation?
Defined as an abnormal awareness of the heart beat. They may notice that their heart beat skips a beat or has an irregular rhythm, is beating faster or slower than normal or is beating with greater strength.
What are some normal scenarios where palpitations may occur?
- exercise
- coffee
- anxiety
- but they may also occur due to problems
What are some pathological conditions where palpitations may arise?
- heart disease
- overactive thyroid gland
- anaemia
- anxiety
- congenital arrhythmia
How do patients describe palpitations?
- pounding
- thumping
- fluttering
- flopping
- skipping beats
- heart stopped
What is the process behind an arrhythmia?
In an arrhythmia, the heart isn’t perfusing oxygen effectively and so it can cause pain or damage - palpitations are a symptom of this.
It is not necessarily an irregularity that is pathological but is most certainly an irregularity in the physiological process of SA –> AV–> Purkinje fibres & bindle of His.
Which of the cardinal features are important for Palpitations?
Quality Severity Time Course Context R/A Associated Medical History Meds/Allergy Family History
What should you ask for Quality
- irregular or regular palpitations
- tap it out for me?
- forceful/fluttering
What should you ask for Severity?
Time course if often an indication of severity.
- fast onset or slow progression
- how fast the beats are during the episode
What should you ask for time course?
- Onset (sudden is more likely to have a serious underlying cause)
- duration
- Offset
- Previous experience
What should you ask for Context?
- At rest? During activity?
- Drug use? Caffeine?
- Stress?
What should you ask for relieving and aggravating factors?
- anything improve the palpitations
- aggravating factors may be exercise, stress or coffee
What other associated features may be present?
- SOB
- Chest pain
- Fatigue
- Dizziness
- Blackouts
Ask about:
- other pain
- other symptoms
- medication
What are two common arrythmias?
Supraventricular Tachycardia (SVT): common in young people–> high regular HR; due to bypass of the SA node
Atrial Fibrillation (AF): more common in elderly –> irregular fast HR
What is signposting?
Lets the patient know that you are changing the direction of the interview or the reasoning behind the questions you are asking so as to keep them involved in your thought process
