palpitation心悸英语.pptx

PalpitationZhou YunThe Affiliated Hospital of Medical College of Ningbo UniversityEmergency DepartmentObjectiveDefinitionEtiology and pathogenesisDifferential diagnosisDiagnosisManagementDefinitionUncomfortable awareness of heart beat or undue awareness of heart action.Defined as thumping,pounding or fluttering sensation in the chest.Intermittent or Sustained Regular or IrregularEtiology and PathogenesisPalpitation is due toAlteration in heart rateSinus tachycardia&BradycardiaAlteration in heart rhythmAtrial fibrillationAugmentation of myocardial contractionAnxiety states&DrugsFEATURESUGGESTSHEART MISSES AND THUMPSECTOPIC BEATSWORSE AT RESTECTOPIC BEATSVERY FAST REGULARSVT(supraventricular tachycardia)/VT(ventricular tachycardia)SUDDEN ONSETSVT/VTOFFSET WITH VAGAL MANOEUVRESSVTFAST AND IRREGULARAF(atrial fibrillation)and ATRIAL FLUTTER with varying blockFORCEFUL AND REGULAR NOT FASTAWARENESS OF SINUS RHYTHM(ANXIETY)SEVERE DIZZINESS OR SYNCOPEVT or BRADYARRHYTHMIASPRE-EXISTING HEART FAILUREVTCauses of PalpitationsCARDIAC43%PSYCHIATRIC31%MISCELLANEOUS10%UNKNOWN16%Cardiovascular CausesArrhythmiasPremature atrial and ventricular contractionsSupraventricular and ventricular arrhythmiasWPW(Wolff-Parkinson-White)syndromeAtrial fibrillationAtrial flutter with varying blockBrady-arrhythmias:complete heart blockSick-sinus syndromeCardiovascular CausesNon-arrhythmic cardiac causesMitral valve prolapse(with or without associated arrhythmias)Aortic insufficiencyAtrial myxomaPulmonary embolismCongenital heart diseasesSystemic hypertensionPericarditisPacemaker induced tachycardiaPsychiatric CausesInclude Panic attacksAnxiety statesSomatizationPsychiatric CausesFeature A longer duration of sensation 15min Multiplicity of symptoms Cardiac evaluation still may be necessary in patients with suspected panic disorder.Arrhythmic causes must be ruled out before the diagnosis of anxiety or panic disorder Miscellaneous CausesHyperkinetic circulatory states:AnaemiaFever Thyrotoxicosis Hypoglycemia PhaeochromocytomaMiscellaneous CausesDrugs:Aminophylline Atropine Thyroxine Tricyclic antidepressants VasodilatorsDigitalisMiscellaneous CausesOthers :CaffeineCocaine Amphetamines Tobacco EthanolOthersSpontaneous skeletal muscle contractions of the chest wallSystemic mastocytosisPhysiological causesExertion Excitement PregnancyNeurocirculatory astheniaVaso-vagal attackAPPROACH TO THE PATIENT WITH PALPITATIONS“Principal goal in assessing patients with palpitations is to determine if the symptom is caused by a life threatening arrhythmia”HOW TO EVALUATE PALPITATIONSTEP 1Is palpitation continuous or intermittent?Intermittent P.are commonly caused by premature atrial or ventricular contractionsVentricular end-diastolic dimensionPost-extrasystolic potentiationHOW TO EVALUATE PALPITATIONSTEP 2Is heart beat regular or irregular?Regular,sustained palpitationsSVT(supraventricular tachycardia)and/or VT(ventricular tachycardia)Irregular,sustained palpitationsAtrial fibrillationHOW TO EVALUATE PALPITATIONSTEP 3:What is the heart rate?STEP 4:Does palpitations occur in discrete attacks?Is onset abrupt?What can terminate attacks?Ventricular arrhythmias are onset suddenlyHolding breath or vagal manoeuvres decrease palpitations in SVTSTEP 5Are there any associated symptoms?Chest pain:Arrhythmogenic MI(myocardial infarction)Dyspnea:Heart failure due to arrhythmiasSyncope:Low cardiac output during arrhythmias,hypoglycemia,phaeochromocytomaSweating:Anxiety,hypoglycemiaDiarrhoea:ThyrotoxicosisHOW TO EVALUATE PALPITATIONSTEP 6:Are there any precipitating factors?Exercise Stress Alcohol intakeDrugsSTEP 7:Is there a history of structural heart disease?Coronary heart diseasesValvular heart diseasesHOW TO EVALUATE PALPITATIONPhysical examinationVital signsJugular venous pressure and pulseAuscultation of the chest and precordiumExaminationECGResting ECGExercise ECG24-hour ECG ExaminationOthersHolterLoop recordings(external or implantable)Mobile cardiac outpatient telemetry.Event recorderExaminationHolter monitorImplantable loop recordersMobile cardiac outpatient telemetryManagement in a Nutshell1.Re-assurance2.Lifestyle modification3.Correction of co-morbid diseases4.Anxiolytics and Beta-blockers5.Anti-arrhythmic drugs/electrical conversionRecurrent life-threatening ventricular arrhythmias are currently being treated with Implantable Cardioverter-defibrillator devicesThank You