heart and blood vessel disorders
Palpitations
Evaluation of Palpitations
Although not all palpitations are caused by a heart disorder, the consequences of some heart disorders are so serious that people with palpitations should usually be evaluated by a doctor. The following information can help people decide when to see a doctor and help them know what to expect during the evaluation. In people with palpitations, certain symptoms and characteristics are cause for concern. They include Light-headedness or fainting Chest pain or pressure Shortness of breath Pulse rate over 120 per minute or less than 45 per minute Having heart disease or a family history of sudden death, recurrent fainting, or unexplained seizure disorder Symptoms occur during exercise, particularly if they cause loss of consciousness People who have palpitations and any warning signs should go to an emergency department right away, as should those who have continuous, ongoing palpitations. Those who have fainting, chest pain, or shortness of breath should call emergency services. People without warning signs who have occasional palpitations or had an episode that stopped should call their doctor. The doctor will determine how quickly they need to be seen based on their age, underlying conditions, and other symptoms. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination helps determine the possible cause. Doctors ask How often palpitations occur How long palpitations last What factors (for example, emotional distress, activity, or intake ofcaffeineor other drugs) trigger or worsen palpitations What drugs, includingcaffeine, the person is taking Sometimes doctors ask the person to tap out the rate and cadence of palpitations because the pattern of beats can help them determine the cause. The physical examination begins with the doctor checking the vital signs (pulse, temperature, and blood pressure). The pulse rate and whether the pulse is regular or irregular help suggest causes. An elevated temperature suggests fever is the cause. A low blood pressure does not suggest a cause but indicates extreme urgency. Doctors listen to the heart for abnormal sounds that might indicate a valve disorder or heart inflammation. They listen to the lungs for sounds that indicate heart failure. They look at and feel the front of the neck to see if the thyroid gland is enlarged or inflamed. Palpitations that occur with other symptoms, such as shortness of breath, chest pain, weakness, fatigue, or fainting, are more likely to result from an abnormal heart rhythm or a serious disorder. Even though most causes of palpitations are not serious, testing typically is done. Electrocardiography (ECG), sometimes with ambulatory monitoring Laboratory testing Sometimes imaging studies, stress testing, or both Sometimes electrophysiologic testing Electrocardiography None is needed. Doctors do a complete blood count and measure serum electrolytes, including potassium, magnesium, and calcium. Doctors may measure other substances in the blood (cardiac markers) if the person has other symptoms that suggest a possible Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) . Doctors measure levels of thyroid hormone in the blood if they suspect an overactive thyroid and measure levels of other hormones in people who may have is sometimes needed. In people with ECG findings that suggest heart disease, doctors do Echocardiography and Other Ultrasound Procedures and sometimes Electrophysiologic Testing None 