Page 22 - Clinical Pearls in Cardiology

10 Clinical Pearls in Cardiology

15. How will you approach a case of palpitation?
Palpitation is defined as an uncomfortable awareness
of one’s own heartbeat. The most common cause of
palpitation is cardiac arrhythmias. Structural heart
diseases and several noncardiac causes can also result
in palpitation. Mitral valve prolapse is the most common
structural heart disease leading to palpitation (Table 2).

Table 2: Clinical correlation of palpitation
Symptom Etiology
• Feeling of a missed beat Ectopic beats
• Feeling of a heavy “thud” due to
awareness of post-extrasystolic beat
• Pounding feeling in the neck AV dissociation
• Rapid regular neck pulsations due to
cannon A waves (Frog’s sign)
• Fast irregular palpitation associated with Atrial fibrillation
dyspnea or chest pain
• Fast palpitation of abrupt onset which Supraventricular
may terminate rapidly tachycardia
• Fast palpitation associated with polyuria
• Termination of palpitation by adopting
vagal maneuvers

A patient can have uncomfortable awareness of the
normal sinus rhythm because of heightened perception in
conditions like anxiety. Forceful contraction of the heart
in hyperdynamic states like fever, thyrotoxicosis, anemia,
pregnancy, strenuous exercise, aortic regurgitation, etc.
can also be perceived as palpitation.
16. What are the factors that increase the likelihood of a
cardiac etiology of palpitation?
Several series of patients seen in primary care settings
have provided information on the clinical epidemiology