Palpitation classification

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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

Palpitations may be classified based on cause, duration, rhythm and clinical presentation.

Classification

• Based on cause, palpitations may be classified as :
  1. Cardiac -Arrhythmia related
  2. Cardiac – Not Related to Arrhythmia
  3. Pharmacological
  4. Psychiatric
  5. Systemic Causes
• Based on clinical presentation, palpitations may be classified as :
  1. Extrasystolic
  2. Tachycardic
  3. Anxiety-related
  4. Intense
• Based on duration, palpitations may be classified as :
  1. Persistent or sustained
  2. Poorly sustained/ short lasting
• Based on rhythm, palpitations may be classified as :
  1. Regular
  2. Irregular
• Extrasystolic palpitations are often described as missed beats which are sudden in onset and occur at rest.
• Tachycardiac palpitations are often described as a fluttering sensation in the chest which is sudden in onset.
  • Tachycardic palpitations include ventricular tachycardias, AV re-entry tachycardia, AN Nodal re-entry tachycardia, atrial fibrillation, atrial tachycardias and atrial flutter.
  • It is associated with a regular or irregular increase in heart rate and symptoms such as syncope, chest pain, breathlessness and neck pulsations.
• Anxiety related palpitations as the name suggest are mostly seen in individuals with generalized anxiety disorder and are gradual in onset.
  • It is associated with an increase in heart rate and symptoms such as a ‘lump-like’ sensation in throat and tingling sensations in the hands and face.
• Patients experiencing a pulsation type of palpitations often feel like their heart is pounding.
  • This sensation is gradual in onset, triggered by exertion and may be associated with asthenia.