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{{CMG}} '''Associate Editor-In-Chief:'''  {{CZ}}
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==Medical Therapy==
Treating heart palpitations depends greatly on the nature of the problem. In many patients, excessive caffeine intake triggers heart palpitations. In this case, treatment simply requires [[caffeine]] intake reduction. If it's been determined that caffeine is not the cause, another dietary consideration is too little magnesium, particularly in pre-menopausal women.  A supplement of equal dosages of magnesium and calcium may be helpful in eliminating palpitations. For severe cases, medication is often prescribed.


A variety of medications manipulate heart rhythm, which can be used to prevent palpitations. If severe palpitations occur, a [[beta blocker|beta-blocking drug]] is commonly prescribed. These block the effect of [[adrenaline]] on the heart, and are also used for the treatment of [[Angina pectoris|angina]] and high blood pressure. However, they can cause drowsiness, sleep disturbance, depression, impotence, and can aggravate asthma. Other anti-arrhythmic drugs can be employed if [[beta blocker]]s are not appropriate.  
==Overview==
The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]]. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup.


If heart palpitations become severe, anti arrhythmic medication can be injected intravenously. If this treatment fails, [[cardioversion]] may be required. [[Cardioversion]] is usually performed under a short [[general anesthesia]], and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue.  
==Medical Therapy==
 
*The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]].
For some patients, often those with specific underlying problems found in [[ECG]] tests, an electrophysiological study may be advised. This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the [[ECG]] from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i.e. if an electrical "short responds circuit" is shown to have an abnormal rhythm, then a special wire can be used to cut the "short circuit" by placing a small burn at the site. This is known as "[[radiofrequency ablation]]" and is curative in the majority of patients with this condition.
*A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup.
 
*[[Patients]] with no positive findings in their initial [[physical examination]] and [[12 lead ECG]] may be discharged with the advice to follow up with a [[cardiologist]]. <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28613787 | doi= | pmc= | url= }} </ref>
[[Atrial fibrillation]] has been discussed in a separate article. Differential Diagnosis of Palpitation
*[[Patient]]s with documented [[arrythmias]] or worrying symptoms such as [[presyncope]], [[syncope]], [[chest pain]], [[dyspnea]] or [[hemodynamic instability]] require further treatment.
 
*To elucidate the treatment of every underlying cause is beyond the scope of this chapter.
Treatment may include medication to control heart rate, or [[cardioversion]] to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, [[ablation]] of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of stroke.
*[[Arrythmias]] may be treated with [[antiarrhythmics]] or [[invasive electrophysiologic management]]. <ref> name="pmid15742913">{{cite journal| author=Abbott AV| title=Diagnostic approach to palpitations. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 4 | pages= 743-50 | pmid=15742913 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15742913  }} </ref>
 
**[[Premature ventricular contractions]] may be treated with [[beta blockers]], [[amiodarone]] or may be left alone if it is an isolated incident and the [[heart]] is structurally normal.
Also, palpitations are associated with an increased risk of blackouts and even premature death. Generally speaking, serious arrhythmia occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.  
**In general, [[ventricular and atrial ectopics]] are commonly [[benign]] and reassurance along with withdrawal of [[precipitants]] (caffeine, alcohol) is the best treatment in such cases.<ref>{{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}}</ref>
 
*The treatment of [[atrial fibrillation]] and [[atrial flutter]] involves [[rate control]], [[rhythm control]] and [[risk stratification]] for systemic [[anticoagulation]].
Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.
**[[Paroxysmal supraventricular tachycardias]] may be treated with [[vagal maneuvers]], [[antiarrhythmics]] such as [[cardioselective beta blockers]], [[adenosine]] or [[non dihydropyridine calcium channel blockers]]. [[Ablation]] and [[synchronized cardioversion]] are reserved for [[haemodynamically unstable]] patients.
**Sustained [[ventricular tachycardias]] with high risk features like an [[ejection fraction]] < 40% , [[family history]] of [[sudden cardiac death]] or a [[past history]] of [[structural heart disease]] may be referred for an [[electrophysiology study]] or [[implantable cardioverter defibrillator placement]].
**Depending on the degree of [[heart block]], treatment may include reassurance, [[antiarrhythmics]] or [[temporary/permanent pacing]].
*[[Structural heart disease]] such as [[hypertrophic cardiomyopathy]], [[severe valvular heart disease]] and [[congenital heart defects]] may be treated [[surgically]].  
*[[Antidotes]], [[behavioral therapy]] and cessation of [[drug]] intake would be the treatment strategy employed for [[palpitations]] secondary to [[substance abuse]].


==References==
==References==
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Latest revision as of 19:58, 21 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]

Overview

The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.

Medical Therapy

References

  1. "StatPearls". 2020. PMID 28613787.
  2. name="pmid15742913">Abbott AV (2005). "Diagnostic approach to palpitations". Am Fam Physician. 71 (4): 743–50. PMID 15742913.
  3. "Palpitations - an overview | ScienceDirect Topics".