Doctor, I get palpitations very often, if I walk a little, I get palpitation. If someone talks loudly to me, I get palpitations.

Commonest cause of palpitations is anxiety. But I must rule out all other causes.

Are the palpitations always there, throughout the day? “No Doctor.” (In left ventricular hypertrophy, or sustained tacyarrhythmias, they will be always present.)

Do you get the palpitations only during exertion, or even suddenly during rest? “Usually only after exertion.” (if not related to exertion, the palpitations are more likely to be due to arrhythmias)

Are you taking any medications? “No.” (side effect of salbutamol, asodilators)

First feel the pulse carefully for at least 15 seconds. Count the rate.

If tachycardia: SVT, Thyrotoxicosis, and Cardiac lesion like RHD. If irregular? Atrial fibrillation or ectopics.

Look for pallor. (Severe Anemia can cause palpitations)

Examine the neck in sitting position & ask her to swallow, and look for Thyroid swelling. If goiter be present, look thyroid thrill at the upper poles, for the eye signs and for fine tremors of the hands.

Examine the CVS in details.

Look for

 Heaving apex beat of LVH.

Parasternal heave of RVH

Murmurs of RHD

Check the blood pressure. To rule out Hypertension.

Are you a diabetic? (Diabetic patient on treatment may be getting hypoglycemic attacks with palpitations.)

Key points for palpitations: continuous or intermittent? Pulse (Arrhythmia), Pallor, Thyrotoxicosis, CVS, BP, Diabetes.

Action:

If clinically all is normal, treat as anxiety – Tranquilisers + Propranolol (Beta-blocker)

If goiter or tachycardia is seen – ask for serum T3, T4, TSH

If cardiac lesions are detected, ask for ECG, x-ray chest, Echocardiography, and if indicated, Holter monitor test for arrhythmias. Refer to a cardiologist.