Symptoms and Signs – Differential Diagnosis of Cardiac palpitations

Symptoms and Signs – Differential Diagnosis of Cardiac palpitations
Palpitations, characterized by a conscious awareness of one's heartbeat, are typically perceived in the precordial region or in the throat or neck. The patient may characterize them as pounding, jumping, spinning, fluttering, flopping, or as experiencing missed or skipped beats. Palpitations can be categorized as regular or irregular, rapid or slow, and paroxysmal or persistent. While typically inconsequential, palpitations may arise from a heart or metabolic disease, as well as the influence of specific medications

Nonpathologic palpitations may arise with a recently implanted prosthetic valve due to the valve's clicking sound increasing the patient's awareness of their heartbeat. Transient palpitations may occur in response to mental stressors (such as fear, wrath, or anxiety) or physical stressors (such as exercise and fever). They may also be used in conjunction with stimulants, like smoke and caffeine. To assist in characterizing the palpitations, instruct the patient to replicate their rhythm by tapping his finger on a solid surface. An irregular "skipped beat" rhythm indicates premature ventricular contractions, while an episodic rapid pulse that terminates suddenly suggests paroxysmal atrial tachycardia.

URGENT INTERVENTIONS
Inquire about dizziness and dyspnea if the patient reports palpitations. Subsequently, examine for skin that is pale, cold, and clammy. Assess the patient's vital signs, observing for hypotension and an irregular or aberrant pulse. In the presence of these indications, suspect heart arrhythmia. Prepare to initiate cardiac monitoring and, if required, provide electroconvulsive therapy. Initiate oxygen therapy using a mask or nasal cannula. Initiate an intravenous line to deliver an antiarrhythmic, if necessary.

Medical History and Physical Assessment
In the absence of patient distress, do a comprehensive cardiac history and physical examination. Inquire whether he has a cardiovascular or pulmonary condition that could result in arrhythmias. Does the patient possess a history of hypertension or hypoglycemia? Ensure the acquisition of a pharmacological history. Has the patient lately commenced cardiac glycoside therapy? Inquire about the intake of caffeine, tobacco, and alcohol. Subsequently, investigate related symptoms, including weakness, weariness, and angina. Ultimately, auscultate for gallops, murmurs, and atypical respiratory sounds.

Etiological Factors
Acute anxiety attack
Anxiety is the predominant cause of palpitations. Among both children and adults. This disease may present with palpitations, diaphoresis, face flushing, tremors, and a foreboding sense of dread. Patients almost inevitably hyperventilate, potentially resulting in dizziness, weakness, and syncope. Additional common manifestations encompass tachycardia, precordial discomfort, dyspnea, abdominal pain, diarrhea, agitation, and sleeplessness.

Cardiac arrhythmias
Paroxysmal or persistent palpitations may be associated with dizziness, weakness, and weariness. The patient may additionally have an irregular, fast, or bradycardic pulse; hypotension; disorientation; pallor; oliguria; and diaphoresis. Elevated blood pressure. Patients with hypertension may be asymptomatic or may report persistent palpitations, sometimes accompanied by headache, dizziness, tinnitus, and fatigue. His blood pressure generally surpasses 140/90 mm Hg. He may also encounter nausea and vomiting, seizures, and a diminished level of consciousness.

Hypocalcemia
Hypocalcemia generally results in palpitations, weakness, and weariness. It advances from paresthesia to muscular tension and carpopedal spasms. The patient may also display muscle twitching, hyperactive deep tendon reflexes, chorea, and positive Chvostek's and Trousseau's symptoms.

Mitral valve prolapse
Mitral prolapse is a valve condition that can induce paroxysmal palpitations along with acute, stabbing, or throbbing precordial pain. The defining characteristic of this condition is a midsystolic click succeeded by an apical systolic murmur. Accompanying signs and symptoms may encompass dyspnea, disorientation, profound weariness, migraine headache, anxiety, paroxysmal tachycardia, chest discomfort, crackles, and peripheral edema.

Mitral stenosis
Initial manifestations of mitral stenosis generally consist of persistent palpitations, along with dyspnea on exertion and weariness. Auscultation indicates a pronounced S1 or opening snap accompanied by a rumbling diastolic murmur near the apex. Patients may exhibit associated signs and symptoms, including an atrial gallop and, in cases of severe mitral stenosis, orthopnea, dyspnea at rest, paroxysmal nocturnal dyspnea, peripheral edema, jugular vein distention, ascites, hepatomegaly, and atrial fibrillation.

Thyrotoxicosis
A hallmark sign of thyrotoxicosis, persistent palpitations may occur alongside tachycardia, dyspnea, weight loss despite heightened appetite, diarrhea, tremors, anxiety, diaphoresis, heat intolerance, and maybe exophthalmos and thyroid enlargement. The The patient may also exhibit an atrial or ventricular gallop.

Additional Factors
Substances. Palpitations may arise from medications that induce cardiac arrhythmias or elevate cardiac output, including cardiac glycosides, sympathomimetics like cocaine, ganglionic blockers, beta-adrenergic antagonists, calcium channel blockers, atropine, and minoxidil.

Herbal treatments, including ginseng, may elicit unpleasant effects such as palpitations and arrhythmias.

Prepare the patient for diagnostic assessments, including an electrocardiogram and Holter monitoring. Note that even benign palpitations might elicit significant anxiety in the patient. Ensure a tranquil and pleasant setting to alleviate anxiety and potentially reduce palpitations.

Elucidate the requisite diagnostic assessments for the patient and instruct him on methods to mitigate anxiousness.

Pediatric Insights
In children, palpitations frequently arise from fever and congenital heart anomalies, including patent ductus arteriosus and septal abnormalities. Due to the inability of many youngsters to articulate this complaint, prioritize objective assessments, including heart monitoring, physical examinations, and laboratory analyses.