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Posts Tagged ‘palpitation’

                        Palpitation is one of the common symptoms for which cardiac patients are referred. Like dyspnea , palpitation can either be a physiological expression of normally beating heart or a  dangerous pathological state of the heart. This makes this symptom unique and warrants careful evaluation.                                                                                                                                                         By definition palpitation  is abnormal  awareness  of ones own heart beat. Heart is a mechanical organ with multiple mobile anatomical structures. There is  constant  blood  flow in multiple directions . Apart from this the heart   has  it’s unique translational, rotational movement . These intrinsic movements combined with proximity to chest wall  generate vibratory  motion  signals .These signals are generally dampened by the encircling pericardial space .The neural signals responsible for  perception  of palpitation is not clear. If the heart hits against the chest wall it is the  somatic nerves from the chest wall that carries the signal. Vibrations generated within the heart chambers, and  and the  valves  are  carried  by the  myocardial and intravascular  sensors.( Autonomic) 

What are causes of palpitation?

       Cardiac

  • All hyperdynamic circulatory states. It may be generated from either  right or left ventricle or both.
  • Regurgitant lesions ( Mainly Mitral and aortic regurgitation)
  • MVPS*
  • Congenital heart disese ( Mainly left to right shunts-ASD/VSD/etc)
  • Apart from this patients  with prosthetic heart valve, and pacemaker patients can feel their heart beats.
  •  Cardiac arrhythmia .Both tachycardia, and bradycardia . Ventricular ectopic beats are the very common cause .( It is often described as missed beat)

* Mitral valve prolapse, a very benign condition, over diagnosed in the last few decades raised considerable anxiety and palpitations for the patients (mainly after the diagnosis ! ).Now the cardiology community has sought to underplay this entity with strict diagnostic criteria.( Thickened mitral leaflet ,presence of MR both must be present to label a patient  as MVPS)

       Non cardiac

  • Physiological
  • Anxiety state
  • Anemia 

What is the relationship between ejection fraction and palpitation?

                                        Generally palpitation indicate a  hyper kinetic state of heart .The commonest cause of palpitation is  anxiety  state .This also happens in hyper dynamic circulations like anemia , fever, thyrotoxicosis, pregnancy etc . In all these situations palpitation indicate increased force of contraction which   generates high dp/dt(Rate of rise of ventricular pressure)  . So  the left ventricularejection fraction is normal or more than normal . So  presence of  palpitation could be an  indirect evidence  of reasonably good LV function.

    “Patients  with dilated cardiomyopathy or CHF rarely feel their heart beat during exertion , instead they have dyspnea  as the LV force of contraction is less”

What is the significance of palpitation that occur during rest ?

                              Palpitation occurring at rest indicate more often a  pathology.It is invariably due to an cardiac arrhytmia  either tachycardia or bradycardia. Intelligent patients can give accurate information about the  regularity of rhythm , any  extra beats or missed beats . Atrial fibrillation, VPDs  could be  diagnosed by history alone in them !

If palpitation  is associated with visible chest pulsation what is the likely diagnosis ?

    If  significant visible pulsation over chest wall  pulsations are seen   in young adults it could simply mean a hyper dynamic circulation and thin chest wall. Pulmonary arterial pulsations is not normally felt in left 2nd inter costal space.If felt one has to rule out shunt lesions like ASD or pulmonary hypertension.
                    “ASD is the commonest cause  of right ventricular  palpitation “  

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