How to Stop Heart Palpitations
Such palpitations are likely to be of sudden onset, to last for minutes or longer and to be unrelated to anxiety or stress. Specific triggers may be identified such as exercise, and manoeuvres may be found which terminate the arrhythmia. In particular, patients with coronary heart disease or heart failure are at risk of ventricular arrhythmias. Such patients who complain of palpitations or syncope should be considered to have a potentially life-threatening ventricular arrhythmia until proven otherwise.
The occurrence of physiological changes in the body does not guarantee that a person will detect symptoms (Gonder-Frederick et al., 1997). If attention is directed to physical changes, people are more likely to detect symptoms than if their attention is held elsewhere. Everyone has had the experience of feeling less discomfort, and being less likely to detect a physical symptom, when being distracted by something diverting. The personal relevance of the symptom may affect detection for example, a person with heart disease may be very likely to detect palpitations (Cox et al., 1993a). The activity of the person at the time of the physiological change is obviously important. Hypoglycaemic symptoms will be more obvious to the person engaged in active mental effort (McCrimmon et al., 2003), such as sitting an examination, than to the person relaxing and watching television. A doctor engaged in microsurgery may be very sensitive to the onset of tremor. In one laboratory study the...
A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.
Another benign cause of palpitations is ventricular ectopic beats. Very often patients with ectopic beats will have taken their own pulse. As a consequence, they will describe 'missed beats', often followed by a particularly strong heart beat. This is because the premature (ectopic) depolarisation resulted in a low stroke volume producing an impalpable impulse following incomplete left ventricular filling. The subsequent compensatory pause leads to overfilling of the ventricle and a more forceful contraction and greater stroke volume with the next beat. Palpitations of this type occur more often at rest and often subside if the patient gets up and undertakes physical activity.
A 58-year-old woman arrived in the emergency department complaining of sudden onset of palpitations, light-headedness, and shortness of breath. These symptoms began approximately 2 hours previously. On examination, her blood pressure is 95 70 mm Hg, and the heart rate is 140 beats min. An ECG demonstrates atrial fibrillation. The physical examination is otherwise unremarkable.
When use of the CNS stimulants causes insomnia, the nurse administers the drug early in the day (when possible) to diminish sleep disturbances. The patient is encouraged not to nap during the day. Other stimulants, such as coffee, tea, or cola drinks, are avoided. In some patients, nervousness, restlessness, and palpitations may occur. The vital signs are checked every 6 to 8 hours or more often if tachycardia, hypertension, or palpitations occur. Many times these adverse reactions will diminish with continued use as tolerance develops. If tolerance develops, the dosage is not increased.
The patient is monitored continually in the ICU with blood pressure, oxygen saturation and telemetry readings for the first 24 h or until stable. For patient comfort and easy access, it is recommended that arterial line be maintained for frequent arterial blood gas analysis and pressure monitoring. It is usually recommended that the blood gases be monitored closely until the pCO2is less than 60 mmHg (1). Vital signs should be initially monitored at least hourly. Hypotension is commonly seen in these patients. It should be treated appropriately with fluids or vasopres-sors. Further assessment for bleeding should include daily monitoring of the CBC until the chest tube output has decreased and the hematocrit is stable. Telemetry monitoring should be employed until the patient is transferred out of the step-down unit, with close attention paid to any changes in cardiac rhythm, since atrial fibrillation is a common complication in these patients. All changes in pulse rate and reported...
The patient with hyperthyroidism is likely to have cardiac symptoms such as tachycardia or palpitations. Propranolol, a adrenergic blocking drug (see Chap. 21), may be prescribed by the primary health care provider as adjunctive treatment for several weeks until the therapeutic effects of the antithyroid drug are obtained.
If available, an ECG recording NSVT provides more information than a rhythm strip. An ECG may help to identify the site of origin of NSVT. Many patients present with palpitations. If patients describe symptoms linked to exertion, an exercise tolerance test is appropriate. If the symptoms are sporadic, but occur daily, a Holter monitor is the approach of choice. An event monitor can help make the diagnosis in a patient with less frequent palpitations. This device comes in two forms an endless loop recorder worn continuously, which stores information only when activated, or a recorder which is applied intermittently when symptoms occur. An implantable loop recorder (ILR) is now available for less frequent symptoms, although utility in screening for NSVT has not been established. Some ILRs, and even cardiac pacemakers, have automatic recording modes for tachyarrhythmias in addition to patient-activated event storage. A Holter monitor can be used to screen asymptomatic patients.
ARVC is a disease of young adults, with 80 of cases diagnosed before the age of 40 yr (88). There is a marked male predominance (3 1). The prevalence of ARVC has been estimated at 1 5000, which may be an underestimate because of difficulties in diagnosis (89). Most patients request medical attention because of symptoms related to ventricular arrhythmias (such as pre-syncope syncope, palpitations, aborted cardiac arrest, or sudden death), which are commonly provoked by exercise. The ventricular tachycardia (VT) is monomorphic with a left bundle-branch block (LBBB) morphology, which is consistent with the right ventricular origin of the arrhythmia (88) (Fig. 8). Occasionally, sudden death is the first manifestation of the disorder. There appears to be a marked geographic variation in the prevalence of ARVC. In Italy, ARVC is the most common cause of sudden death in athletes, accounting for 25 of cases (90) in the rest of the world, ARVC is implicated in
Quality of life, 2) the specific therapeutic target (e.g., reduction of palpitations, elimination of syncope, reduction of shocks from an implantable cardioverter defibrillator (ICD), prevention of sudden death), 3) the target arrhythmia (e.g., sustained monomorphic VT (SMVT), recurrent ventricular fibrillation (VF), 4) the method to be used to evaluate the drug (e.g., symptoms (PVC) frequency on Holter monitoring, frequency of ICD interventions), and 5) the criteria to be used to define drug success (e.g., 80 reduction in PVC frequency, inability to induce SMVT with programmed electrical stimulation, ICD shock frequency 1 per yr). Even after considerable experience, many of the elements defined before therapy is initiated will change during the course of treatment. However, this initial step provides a framework for subsequent changes, and a basis for educating and informing the patient, health care workers, and payers about the process that is necessary for optimal outcome.
Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient to a specific organ or system.
This is experienced by most healthy subjects at some time. It usually occurs in relation to sympathetic nervous system overactivity, e.g. after strenuous exercise, when given a fright or waiting for an interview or examination. It may he most noticeable in bed at night when external visual and auditory inputs are minimal and visccral sensations more prominent. Similar palpitations occur with excessive caffeine intake in coffee, tea or other drinks. Caffeine (found in tea, coffee, cola, etc.) enhances the action of the sympathetic nervous system hy augmenting the concentration of relevant secondary messengers in the myocardium.
Anxiety is a feeling of fear, worry, uneasiness, or dread. It may be associated with physical problems or drugs and is often prompted by feelings of helplessness or loss of self-esteem. Generalized anxiety disorder (GAD) is characterized by chronic excessive and uncontrollable worry about various life circumstances, often with no basis. It may be accompanied by muscle tensing, restlessness, dyspnea, palpitations, insomnia, irritability, or fatigue.
The features include weight loss with increased appetite, heal intolerance, pruritus, emotional lability, excessive sweating and palpitations. There may he a change in the menstrua cycle, either oligomenorrhoea or amenorrhoea, and in bowel habit as a consequence of intestinal hurry. In elderly patients many of these features may be missing and the presenting features may relate to the development of atrial fibrillation (see p. 85).
Rapid heart action of a paroxysmal tachycardia usually begins and terminates abruptly and causes a pounding sensation in the chest. Patients often will indicate whether the tachycardia is regular or irregular and may be able to tap out the rate and rhythm of the episode (see Chap. 24). Chest pressure suggesting angina may occur with an episode of tachycardia even in young, healthy patients without CAD. Patients with CAD, however, often develop severe angina with a sustained arrhythmia because of increased MV(r)O2. Depending on the rate and mechanism of the arrhythmia, faintness and syncope may be described during questioning. Nevertheless, sustained ventricular tachycardia can occur in the setting of serious underlying cardiac disease without a significant compromise in hemodynamics (see Chap. 24). Syncope due to tachyarrhythmias may occur without the patient being aware of palpitations.
A sensitive, complete history and assessment, along with careful pacing of the emerging therapeutic relationship, will commonly yield ideas about the proper role of hypnotherapy for a particular child. For the common performance anxiety of stage fright, or palpitations or 'butterflies in the stomach' before a big game or a recital, it is often easily demonstrated to the child that their response, like a habit, has become a conditioned reaction association with negative expectations, and that it can in fact learn similarly to be modified and mastered.
Alterations in fetal and maternal heart rates and maternal blood pressure frequently occur when ritodrine is administered IV. Additional frequent adverse reactions associated with IV administration include nausea, vomiting, headache, palpitations, nervousness, restlessness, and emotional upset. A rare, but serious, adverse reaction is pulmonary edema.
Key tests in diagnosing anemia are blood counts, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) (Display 10-2). The general symptoms of anemia include fatigue, shortness of breath, heart palpitations, pallor, and irritability. There are many different types of anemia, some of which are caused by underproduction of red cells, others by loss or destruction of cells.
Decline in vigor and motivation (Kanas and Manzey 2003 Suedfeld 2005). According to Russian space psychologists and flight surgeons, a psychiatric condition that affects the emotional state of cosmonauts during prolonged missions is asthenia. This syndrome, that refers to a psychiatric diagnostic category, is defined as a weakness of the nervous system that may result in fatigue, irritability and emotional liability, attention and concentration difficulties, restlessness, heightened perceptual sensitivities, palpitations and blood pressure instability, physical weakness, and sleep and appetite problems (Kanas et al. 1991 2001a, b Myasnikov and Zamaletdinov 1998). Although ''asthenization'' is carefully monitored, and a number of countermeasures are employed to prevent it from progressing, empirical evidence for its existence as a discrete pathological entity has been equivocal (Kanas et al. 1991, 2001a, b).