STUDY - Technical - New Dacian's Medicine
Palpitations
(Classical / Allopathic Medicine)
Defined
as a conscious awareness of one's heartbeat, palpitations
are usually felt over the precordium or in the throat or
neck. The patient may describe them as pounding, jumping,
turning, fluttering, or flopping or as missing or skipping
beats. Palpitations may be regular or irregular, fast or
slow, paroxysmal or sustained.
Although
usually insignificant, this common symptom may result from
a cardiac or metabolic disorder or from the effects of
certain drugs. Nonpathologic palpitations may occur with a
newly implanted prosthetic valve because the valve's
clicking sound heightens the patient's awareness of his
heartbeat. Transient palpitations may accompany emotional
stress, such as fright, anger, and anxiety, or physical
stress, such as exercise and fever. They can also
accompany the use of stimulants, such as tobacco and
caffeine.
To
help characterize the palpitations, ask the patient to
simulate their rhythm by tapping his finger on a hard
surface. An irregular “skipped beating” rhythm points to
premature ventricular contractions, whereas an episodic
racing rhythm that ends abruptly suggests paroxysmal
atrial tachycardia.
ALERT:
If the patient complains of palpitations:
- ask him about dizziness and shortness of breath; then inspect for pale, clammy skin
- assess his vital signs for hypotension and irregular, abnormal, or rapid pulse; then if these signs are present, suspect cardiac arrhythmia
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient complains of palpitations:
- ask him about dizziness and shortness of breath; then inspect for pale, clammy skin
- assess his vital signs for hypotension and irregular, abnormal, or rapid pulse; then if these signs are present, suspect cardiac arrhythmia
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Review the patient's medical history for a cardiovascular or pulmonary disorder (which may produce arrhythmias), hypertension, and hypoglycemia.
Ask the patient about associated symptoms, such as weakness, fatigue, and angina.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake and caffeine consumption.
Review the patient's medical history for a cardiovascular or pulmonary disorder (which may produce arrhythmias), hypertension, and hypoglycemia.
Ask the patient about associated symptoms, such as weakness, fatigue, and angina.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake and caffeine consumption.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Auscultate the chest for gallops, murmurs, and abnormal breath sounds.
Connect the patient to a cardiac monitor, or obtain an electrocardiogram.
Take the patient's vital signs.
Auscultate the chest for gallops, murmurs, and abnormal breath sounds.
Connect the patient to a cardiac monitor, or obtain an electrocardiogram.
SPECIAL
CONSIDERATIONS:
Herbal remedies, such as ginseng and ephedra, have adverse effects, including palpitations and an irregular heartbeat.
Herbal remedies, such as ginseng and ephedra, have adverse effects, including palpitations and an irregular heartbeat.
PEDIATRIC
POINTERS:
Palpitations in children commonly result from fever and congenital heart defects, such as patent ductus arteriosus and septal defects.
Because young children commonly can't describe this complaint, focus your attention on objective measurements, such as cardiac monitoring, physical assessment, and laboratory tests.
Palpitations in children commonly result from fever and congenital heart defects, such as patent ductus arteriosus and septal defects.
Because young children commonly can't describe this complaint, focus your attention on objective measurements, such as cardiac monitoring, physical assessment, and laboratory tests.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include an electrocardiogram and Holter monitoring.
Instruct the patient on what to expect from diagnostic testing, which may include an electrocardiogram and Holter monitoring.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.