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What are the signs and symptoms of palpitations?
Palpitations describe an irregularity of the heartbeat as felt by the patient. They may be felt as an isolated skipped beat or they may be frequent and recurrent. Palpitations may also be rapid and either regular or irregular. This may lead to the patient describing a fluttering in their chest.
Patients may also complain of fullness in their chest or throat. There may also be associated shortness of breath, nausea, and sweating. If the heart rate is very fast, the patient's blood pressure may fall causing lightheadedness and the sensation that they might pass out. Syncope, where the patient actually does faint or pass out, may occur depending upon the cause of palpitations.
How are palpitations diagnosed?
Palpitations may be difficult to diagnose, since often the symptoms are intermittent and may not be present when the patient presents for care.
As with most medical conditions, the key to making the diagnosis lies in the history and physical examination. The health care professional may ask questions to understand the sensation felt by the patient:
- Are the palpitations an isolated extra or skipped beat or are there runs that can last for minutes or hours? What makes them come on? What makes them go away?
- What other symptoms might be present, including shortness of breath, chest pain, sweating, nausea and vomiting, lightheadedness, and syncope?
- Past medical history is important, including a history of heart or lung disease and prescribed medications.
- Knowing whether other medications or drugs are being used will be helpful. These include caffeine, over-the-counter medications, herbal medications, alcohol, and illegal drugs that may affect the heart (for example, cocaine, amphetamines, and others).
Physical examination will often concentrate on the heart and lungs, but may also focus on other organ systems if it is appropriate.
Blood tests may be helpful to look for underlying medical conditions that may cause palpitations. These may include a complete blood count (CBC) or hemogram looking for anemia (low red blood cell count), electrolytes, kidney, and thyroid function.
Often the patient does not present when the palpitations are present but an electrocardiogram (EKG) may still be helpful in looking for indirect evidence as to the potential cause. A heart monitor may be useful because some patients are unaware that they have PACs or PVCs and this may help make the diagnosis.
It may be frustrating for the patient to present to the health care professional or emergency department complaining of palpitations, only to find that they have stopped by the time they are evaluated. Unless there is concern about a life-threatening situation, most patients with palpitations are evaluated as outpatients. There are a variety of heart monitors that can be worn for days or months at a time that can record and even notify the health care professional if a significant heart rhythm abnormality is detected.
In certain circumstances, the heart rhythm might be evaluated by electrophysiological studies, where the electrical system of the heart is mapped out. The process is similar to a heart catheterization, but the catheter enters a vein instead of an artery. The long catheter and electrode is guided into the heart and used to evaluate the electrical pathways inside the heart muscle. In addition to being diagnostic, sometimes short circuits may be found and treated by ablation or destroying the abnormal circuit. Wolff-Parkinson-White syndrome is often treated in this way.