上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 2 Palpitation

Palpitation

Palpitation

Definition Palpitation may be defined as an awareness of the beating of the heart, an awareness most commonly brought about by a change in the hearts rhythm or rate or by an augmentation of its contractility

Definition Palpitation may be defined as an awareness of the beating of the heart, an awareness most commonly brought about by a change in the heart's rhythm or rate or by an augmentation of its contractility

Definition a Palpitation is not pathognomonic of any particular group of disorders; indeed, often it signifies not a primary physical disorder but rather a psycho disturbance a The diagnosis of the underlying disease is made largely on the basis of other associated symptoms and the data

Definition ◼ Palpitation is not pathognomonic of any particular group of disorders; indeed, often it signifies not a primary physical disorder but rather a psychio disturbance. ◼ The diagnosis of the underlying disease is made largely on the basis of other associated symptoms and the data

Characteristics Concern is more pronounced in patients who know or who have been told that they may have heart disease to them palpitation may seem to be an omen of impeding disaster

Characteristics ◼ Concern is more pronounced in patients who know or who have been told that they may have heart disease; to them palpitation may seem to be an omen of impeding disaster

Characteristics a The resulting anxiety may be associated with increased activity of the autonomic nervous system, with consequent increases of the cardiac rate and rhythm and the vigor of contraction, the patients awareness of these changes may then lead to a vicious cycle, which ultimately be responsible for this incapacitation

Characteristics ◼ The resulting anxiety may be associated with increased activity of the autonomic nervous system, with consequent increases of the cardiac rate and rhythm and the vigor of contraction, the patients awareness of these changes may then lead to a vicious cycle, which ultimately be responsible for this incapacitation

Characteristics a Palpitation may be described in various terms, such as"fluttering ,"flopping",and skipping In most cases the complaint is of a sensation of disturbed heartbeat a There's wide variability in the sensitivity to alteration in cardiac activity among different individuals

Characteristics ◼ Palpitation may be described in various terms, such as "fluttering", "flopping", and "skipping“. In most cases the complaint is of a sensation of disturbed heartbeat. ◼ There’s wide variability in the sensitivity to alteration in cardiac activity among different individuals

Variability of the sensitivity a Some patients seem to be unaware of the most serious and chaotic dysrrhythmias others are seriously troubled by an occasional extrasystole The awareness of the heartbeat tends to be more common at night and during introspective moments, but is less marked during activity

Variability of the sensitivity ◼ Some patients seem to be unaware of the most serious and chaotic dysrrhythmias; others are seriously troubled by an occasional extrasystole. ◼ The awareness of the heartbeat tends to be more common at night and during introspective moments, but is less marked during activity

Variability of the sensitivity Patients with organic heart disease and chronic disorders tend to accommodate to these abnormalities and are often less sensitive than normal persons to such events Palpitation is particularly prominent when the precipitating cause for increased heart rate or contractility or arrhythmia is recent transient, and episodic

Variability of the sensitivity ◼ Patients with organic heart disease and chronic disorders tend to accommodate to these abnormalities and are often less sensitive than normal persons to such events. ◼ Palpitation is particularly prominent when the precipitating cause for increased heart rate or contractility or arrhythmia is recent, transient, and episodic

Accompanied Symptom 冷 Precordial pain 今 Fever yncope or spasm Anemia 今 Tabification

Accompanied Symptom ❖ Precordial pain ❖ Fever ❖ Syncope or spasm ❖ Anemia ❖ Tabification

Mechanism > Increased Stroke Volume Tachycardia Arrhythmia Individual differences

Mechanism ➢ Increased Stroke Volume ➢ Tachycardia ➢ Arrhythmia ➢ Individual differences