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==Overview==
==Overview==
People describe their palpitations in many different ways, including a sense that their heart stopped, that there's fluttering in the chest, that they are anxious or panicked, or that it comes on when they stand up.
People describe their palpitations in many different ways, including a sense that their heart stopped, that there's fluttering in the chest, that they are anxious or panicked, or that it comes on when they stand up.
===The Heart "Stops"===
Those who experience palpitations may have the feeling that their heart stops beating for a moment, and then starts again with a "thump" or a "bang". Usually this feeling is actually caused by an extra beat (premature beat or [[extrasystoles|extrasystole]]) that happens earlier than the next normal beat, and results in a pause until the next normal beat comes through. People are not usually aware of the early, extra beat, but may be aware of the pause, which follows it (the heart seems to stop). The beat after the pause is more forceful than normal, giving the "thumping" sensation.
===The Heart is "Fluttering" in the Chest===
Any rapid heartbeat (or [[tachycardia]]) can give rise to this feeling. A rapid, regular fluttering in the chest may be associated with sensation of pounding in the neck as well, due to simultaneous contraction of the upper, priming chambers of the heart (the [[atria]]) and the lower, main pumping chambers (the [[ventricles]]). If the fluttering in the chest feels very irregular, then it is likely that the underlying rhythm is [[atrial fibrillation]]. During this type of rhythm abnormality, the atria beat so rapidly and irregularly that they seem to be quivering, rather than contracting. The ventricles are activated more rapidly than normal (tachycardia) and in a very irregular pattern.
===Feelings of Anxiety or Panic===
Palpitations may be associated with feelings of anxiety or panic. It is normal to feel the heart thumping when feeling terrified or scared, but it may be difficult to know whether the palpitations or the panicked feeling came first. Unfortunately, since it can take some time before a clear diagnosis is made in a patient complaining of palpitations, people are sometimes told initially that the problem is anxiety.
Stressful situations cause an increase in the level of stress hormones, such as [[adrenaline]], circulating in the blood, and there are some types of abnormal heart rhythm that can be stimulated by adrenaline excess, or by exercise. It may be possible to diagnose these sorts of palpitations by performing simple tests, such as an exercise test, while monitoring the [[ECG]].
===Changes in Posture===
Some types of abnormal heart rhythm seem to be affected by posture. For many people, standing up straight after bending over can provoke a rapid heart rate. Often these attacks can be abolished again by lying down. Many people, if not all, are more aware of the heartbeat when lying quietly in bed at night. This is partly because at that time, the attention is not focused on other things, but also because the slower heart beat at rest can allow more premature beats to occur.
==Overview==
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].


==Classification==
==Classification==


There is no established system for the classification of [disease name].
*Based on '''cause''', palpitations may be classified as : <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28613787 | doi= | pmc= | url= }} </ref>
 
*#Cardiac -Arrythmia related,
OR
*#Cardiac – Not Related to Arrythmias
 
*#Pharmacological
[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
*#Psychiatric
*[Group1]
*#Systemic Causes
*[Group2]
*Based on '''clinical presentation''', palpitations may be classified as :
*[Group3]
*#Extrasystolic
*[Group4]
*#Tachycardic
 
*#Anxiety-related
OR
*#Intense<ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L | display-authors=etal| title=Management of patients with palpitations: a position paper from the European Heart Rhythm Association. | journal=Europace | year= 2011 | volume= 13 | issue= 7 | pages= 920-34 | pmid=21697315 | doi=10.1093/europace/eur130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315  }} </ref>
 
*Based on '''duration''', palpitations may be classified as :  
[Disease name] may be classified into [large number > 6] subtypes based on:  
*#Persistent or sustained
*[Classification method 1]
*#Poorly sustained/ short lasting
*[Classification method 2]
*Based on '''rhythm''', palpitations may be classified as :
*[Classification method 3]
*#Regular
 
*#Irregular
[Disease name] may be classified into several subtypes based on:  
*Extrasystolic palpitations are often described as missed beats which are sudden in onset and occur at rest.
*[Classification method 1]
*Tachycardiac palpitations are often described as a fluttering sensation in the chest which is sudden in onset.
*[Classification method 2]
**Tachycardic palpitations include ventricular tachycardias, AV re-entry tachycardia, AN Nodal re-entry tachycardia, atrial fibrillation, atrial tachycardias and atrial flutter.
*[Classification method 3]
**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.  
OR
**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.
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
**This sensation is gradual in onset, triggered by exertion and may be associated with asthenia.  
 
OR
 
'''If the staging system involves specific and characteristic findings and features:'''
 
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==References==
==References==

Revision as of 17:49, 6 August 2020

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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]Cafer Zorkun, M.D., Ph.D. [3]

Overview

People describe their palpitations in many different ways, including a sense that their heart stopped, that there's fluttering in the chest, that they are anxious or panicked, or that it comes on when they stand up.

Classification

  • Based on cause, palpitations may be classified as : [1]
    1. Cardiac -Arrythmia related,
    2. Cardiac – Not Related to Arrythmias
    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[2]
  • 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.

References

  1. ↑ "StatPearls". 2020. PMID 28613787.
  2. ↑ Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L; et al. (2011). "Management of patients with palpitations: a position paper from the European Heart Rhythm Association". Europace. 13 (7): 920–34. doi:10.1093/europace/eur130. PMID 21697315.

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