11/13/2022 0 Comments Chest flutter feeling![]() The complete history will provide evidence as to the clinical significance of the symptom and the underlying arrhythmia. A family history of arrhythmias may suggest preexcitation or long Q-T interval syndromes. These include emotional and physical stress, fatigue, febrile illnesses, thyrotoxicosis, and caffeine or alcohol ingestion, in addition to drug toxicity (antiarrhythmic agents, cardiac glycosides) and worsening of any underlying cardiac disease. The examiner should also seek precipitating factors or systemic diseases that may provide both a key to understanding the pathophysiology of the symptoms and a possible therapeutic approach. Regular, slow beats during rest or at night typically reflect heightened awareness of normal cardiac rhythm in an anxious patient. Palpitations during exercise, particularly in an unconditioned patient, or during emotional episodes may reflect a normal sinus tachycardia in a patient with coronary artery disease, a ventricular arrhythmia caused by exercise-induced myocardial ischemia may also be suspected. The history may likewise suggest a pathophysiologic mechanism for the presumed arrhythmias. It is important to recognize, however, that these diagnostic hints are only suggestive a conclusive diagnosis depends on electrocardiographic recordings during a symptomatic episode. The examination may be aided by asking the patient to tap the rhythm or to choose from several cadences tapped by the physician. In patients with ventricular demand pacemakers, palpitation may occur with beginning and/or ending of demand pacing. Syncope following an episode suggests sinus node dysfunction with overdrive suppression of normal pacemaker function after a bout of atrial tachyarrhythmia. Paroxysmal atrial fibrillation is often described as beats irregular in both rhythm and strength, whereas sinus tachycardia is of gradual onset and offset with a regularly increasing and decreasing heart rate. Polyuria may follow paroxysmal supraventricular tachycardia. Single "skips" suggest isolated premature extrasystoles, whereas the abrupt onset and termination of rapid, regular palpitations characterize paroxysmal supraventricular or ventricular tachycardia. Once a cardiac origin is suspected, the detailed history may provide clues as to the type of arrhythmia. In yet other cases, a noncardiac vascular origin of the symptom may exist, as in hypertension, aortic regurgitation, and tricuspid regurgitation with exaggerated pulsations of the arterial or venous systems. A fleeting "sinking" feeling may also be described this is particularly common in patients with isolated extrasystoles and may correspond to the post-extrasystolic compensatory pause.Ī report of seeing the chest move or "flutter" may suggest chest wall muscle fasciculations. Any of these may reflect a cardiac irregularity. Terms commonly used include "skip beats," "racing," "pounding," "fluttering," as well as numerous others. These range from a nonspecific cardiac awareness to discrete episodes of rapid beats. Various terms may be used to describe the sensation. The history of palpitations may provide information as to the cardiac origin of the sensation, the type of rhythm disturbance responsible, and the clinical significance of the symptom. ![]()
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