Palpitations - Clinical Symptoms

Palpitations

A palpitation is an increased awareness of the heartbeat. It may be a fluttering, rapid sensation or a slow, some-times heavy thumping sensation. The patient may feel ‘a missed beat’, or their heart beating irregularly.

It is important to try to elicit from the patient when the palpitations occur, precipitating factors, duration, rate and rhythm (ask the patient to tap out the beat with their hand). Associated symptoms may include breath-lessness, dizziness, syncope and/or chest pain.

·        Palpitations during or just after exercise, or caused by anxiety are often simply awareness of a normal heart rate.

·        Palpitations lasting just a few seconds are often due to premature beats. The patient becomes aware of the pause that occurs in the normal rhythm after a premature beat and may sense the following stronger beat.

·        Post-palpitation polyuria is a feature of supraventricular tachycardia due to the release of atrial natriuretic peptide. Some patients may know how to terminate their rapid palpitations with manoeuvres such as squatting, straining or splashing ice-cold water on the face. These features are very suggestive of a distinct tachyarrhythmia rather than general anxiety or premature beats.