Palpitations

Question 1

What is a palpitation?

Answer 1

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.

Question 2

What are some normal scenarios where palpitations may occur?

Answer 2

• exercise
• coffee
• anxiety
• but they may also occur due to problems

Question 3

What are some pathological conditions where palpitations may arise?

Answer 3

• heart disease
• overactive thyroid gland
• anaemia
• anxiety
• congenital arrhythmia

Question 4

How do patients describe palpitations?

Answer 4

• pounding
• thumping
• fluttering
• flopping
• skipping beats
• heart stopped

Question 5

What is the process behind an arrhythmia?

Answer 5

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.

Question 6

Which of the cardinal features are important for Palpitations?

Answer 6

Quality
Severity
Time Course
Context
R/A
Associated
Medical History
Meds/Allergy
Family History

Question 7

What should you ask for Quality

Answer 7

• irregular or regular palpitations
• tap it out for me?
• forceful/fluttering

Question 8

What should you ask for Severity?

Answer 8

Time course if often an indication of severity.

• fast onset or slow progression
• how fast the beats are during the episode

Question 9

What should you ask for time course?

Answer 9

• Onset (sudden is more likely to have a serious underlying cause)
• duration
• Offset
• Previous experience

Question 10

What should you ask for Context?

Answer 10

• At rest? During activity?
• Drug use? Caffeine?
• Stress?

Question 11

What should you ask for relieving and aggravating factors?

Answer 11

• anything improve the palpitations

- aggravating factors may be exercise, stress or coffee

Question 12

What other associated features may be present?

Answer 12

• SOB
• Chest pain
• Fatigue
• Dizziness
• Blackouts

Ask about:

• other pain
• other symptoms
• medication

Question 13

What are two common arrythmias?

Answer 13

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

Question 14

What is signposting?

Answer 14

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