Hello, welcome everybody, this is doctor Bolad, board certified physician in cardiology, interventional
cardiology and internal medicine, certified by the American Board of Internal Medicine.
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Today I will talk to you about palpitations. Palpitations are the unpleasant awareness
of the forceful, rapid, or irregular beating of the heart. Sometimes they are described
as the sensation as a rapid fluttering or a flip-flopping in the chest, or a pounding
sensation in the chest or neck. The cause is usually benign, but sometimes palpitations
might be a manifestation of a potentially life-threatening arrhythmia. There are multiple
causes for palpitations. These include: 1- Cardiac causes include irregularities in
which the heart is beating fast or slow or having extra beats. These can be a manifestation
of structural heart disease such as cardiomyopathies, underlying heart conduction abnormality, medical
conditions such as lung disease, or can sometimes occur for unknown reasons. Palpitations can
also sometimes occur in Mitral Valve Prolapse and in cardiac shunts.
2- High Output States, such as the ones that occur in normal pregnancy, anemia or fever.
3- Metabolic diseases, such as hypoglycemia, hyperthyroidism and pheochromocytoma.
4- Catecholamine excess, as occurs in stress and exercise
5- Substance abuse, as occurs in alcohol abuse, cocaine abuse nicotine and coffee abuse
6- Medications, as occurs with intake of Sympathomimetic agents which are found in cold remedies that
we get over the counter 7- Psychiatric disorders, as occurs in generalized
anxiety disorders and panic disorders. Investigations that would help us in defining
the palpitations include: 1- The 12 lead ECG tracing. This is required
as the initial test for all patients with palpitations. This would tell us the baseline
rate, rhythm and extra beats and would give us an idea about where these extra beats are
originating from in the heart. 2- Ultrasound scan of the heart, generally
referred to as an echocardiogram. This would give us a good idea about the heart function
and whether there is heart disease. 3- Ambulatory heart rhythm monitor. A monitor
is a small device that is attached either directly or by leads to the chest wall, and
record the heart activity for different periods ranging from one day to one month. These will
document the highest and lowest heart rates and irregularities in the heart beating. If
the patient feels the palpitations while wearing a monitor, then the patient can press a button
to mark the time on the tracing so we can go back and look into what the heart pattern
was, when he or she felt the palpitation.
4- Routine blood tests such as thyroid function test, kidney function test, liver function
test, glucose levels and others will tell us about any chemical abnormality that might
be contributing to the palpitations. Treatment of patients with palpitations depends
on the suspected or identified cause. When a medical cause of the palpitations is identified,
we proceed with treatment of the identified cause. For patients with palpitations that
no cause was identified, the role of anxiety or panic disorder should be explored. For
those patients with palpitations that are associated with documented normal heart beating
pattern on the ambulatory heart rhythm monitor and with an otherwise normal evaluation, we
offer reassurance as to the benign nature of their symptoms.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk
to you soon.