A site for medical students - Practical,Theory,Osce Notes

What is palpitation?

Palpitation is defined as an unpleasant awareness of forceful, arrhythmic or rapid beating of the heart.
What is the mechanism of palpitation?
  • Increase in the rate of contraction
  • Increase in the force of contraction
  • Change in the rhythm of contraction
Clinical  types of palpitation
Clinically two types of palpitation is present
Exertional palpitation - with organic heart disease, anemia etc.
Paroxysmal palpitation - episodes of palpitation at rest and non-exertional
  • Fast, chaotic irregular palpitation in - atrial fibrillation
  • Fast, regular palpitation in - paroxysmal tachyarrhythmia PSVT and VT
Paroxysmal supraventricular tachycardia (PSVT) is characterized by abrupt onset and abrupt offset that last for several minutes with fatiguability and followed by Polyuria.
Patient should try to replicate the rhythm of palpitation by tapping on a table to know is it a regular or irregular rhythm.
Skipped beat is flopping sensation due to atrial extra systole or ventricular extra systole
The causes of palpitation can be cardiac and non cardiac
Cardiac causes of palpitation are
Valvular heart disease
  • Aortic regurgitation
  • Mital regurgitation
  • Tricuspid regurgitation
  • Mitral stenosis 
Congenital heart disease
  • Atrial septal defect
  • Ventricular septal defect
  • Patent ductas artenosus
Extrasystoles-Atrial, ventricular
Tachyarrhythmias Atrial, ventricular Paroxysmal atrial tachycardia
Atrial fibrillation.
Brady arrhythmia
Noncardiac causes of palpitation are
Hyperkinetic circulatory states such as
  • Severe anemia
  • Thyrotoxicosis
  • Arteriovenous shunt
  • Anxiety
  • Pyrexia
Drugs can cause palpitation they are :
  • Sympathomemetic
  • Vasodilators 
Non organic causes are 
  • Excessive smoking
  • Commonest cause of palpitation is anxiety
  • Idiopathic Prolonged anxietyr state (Soldier's heart, neurocirculatory asthenia. Da Costa's syndrome)
  • Cardiac neurosis
  • Haemorrhagic coma
Others are 
  • Hypoglycemia 
  • Pheochromocytoma,
  • Thyrotoxicosis
  • Psychogenic