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PALPITATIONSPALPITATIONS

Dr. Gatot Sugiharto, SpPD

Department of Internal Medicine

Faculty of Medicine Wijaya Kusuma ni!ersity Sura"aya

Approach toApproach to

the patientthe patientwithwith

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Palpitations

Definition : An awareness of the beatingof the heart

Describe commonly as pounding, flut-

tering, stopping, missing, skipping, jumping,racing, running away, flip flop beats

Usually benign, occasionally a manifesta-

tion of potentially life threateningconditions

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Causes of palpitations

Cardiac origin : arrhythmia, markedlyentricle enlargement

!on cardiac origin : "hyroto#icosis, hypo-glycemia, pheochromocytoma, feer $in-creased catecholamine leels%

Drugs : tobacco, coffee, tea, alcohol, epi-nephrine, ephedrine, aminophilin, atropine

&sychiatric conditions $panic ' depression%

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Marieb EN, Human AnatomyMarieb EN, Human Anatomy

& Physiology,1999; 699& Physiology,1999; 699

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Mehanism

Change in the heart(s rhythm, rate ')orincrease force of contraction* +ncrease of catecholamine $during e#ercise,

stress, panic, hypoglycemia, etc% with decreaseagal tone* adrenergic stimulation hypersensitiity $young

female%* yperkinetic circulation $pregnancy, pheocromo-

cytoma, hypertiroid%* .yncopedecrease cardiac output, acute

asodilatation

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Palpitations 7

Approah to the patients

istory taking: /nset, duration, associatedsymptom ' circumstance in which they occur* Abrupt onset, irregular ' termination in seeral

minute 0" ) .0"

* 1radual onset, regular, pounding heart sinustachycardia

* .kipped, flopping beat atrial)entricular e#trasystole

* .ustained bursts of rapid heart entricular)supraentricular tachyarrhythmia

* .ustained irregular rhythm A2 $hyperthyroid%* .low rhythm A0 block

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Palpitations 9!reene "" H#, et all$ %eision Maingin Me'iine, 199(; 61

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Palpitations 11

Goal Defning potential CV abnormalitiesas a substrate or arrhythmias

Mid systolic click o MV prolapsed SVT/VT

Harsh holosystolic murmur on let sternal borderbstructi!e hypertrophic cardiomyopathy "#$ rarely VT

Dilated cardiomyopathy$ CH# VT$ "#

Heart enlargement "%

Diagnostic testing & The Holter monitor

Continuous'loop e!ent recorder

Treadmill ()ercise testing

Physical examination

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