Jin Yu-hua Dept. of Geriatrics Palpitation Jin Yu-hua Dept. of Geriatrics

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

Definition Palpitation does not means heart disease. The degree of palpitation is not equal to the severity of heart disease. Patients with anxiety states often exhibit a lowered threshold at which disorders of rate and rhythm result in palpitation.

Definition Persistent tachycardia and/or atrial fibrillation(心房颤动) may not be accompanied by continual palpitation. A sudden, brief alteration in cardiac rate or rhythm which often causes considerable subjective discomfort.

Etiology Augmentation of heart contractility Arrhythmia(心律失常) Cardiac neurosis(心脏神经官能症)

Augmentation of heart contractility Physiological augmentation Pathological augmentation

Physiological augmentation Exercising strongly and overnervous After drinking coffee, tea, alcohol Taking medicine such as ephedrine(麻黄素), aminophylline(氨茶碱), atropin(阿托品) etc.

Pathological augmentation Ventricular hypertrophy: such as hypertensive heart disease, valvular insufficiency(瓣膜关闭不全), patent ductus arterious (PDA动脉导管为闭), ventricular septal defect (VSD室缺) etc. Heart preload or afterload increase → hypertrophy → augmentation of contractility → palpitation

Pathological augmentation Other diseases which increase cardiac output: Thyrotoxicosis(甲亢): basic metabolism amplify & sympathetic nerve excite→heart rates↑ Anemia(贫血): hypoxaemia → heart rates ↑ mild, chronic anemia may cause palpitation during exertion. severe, acute anemia may cause palpitation at rest.

Fever: basic metabolism amplify Hypoglycemia(低血糖): Palpitation is often a prominent feature of the condition and appears to be release of catecholamine(儿茶酚胺).

Arrhythmia Tachycardia: sinus, supraventricular, ventricular Bradycardia: SSS, AVB, sinus bradycardia diastolic period prolong → EDV↑ → augmentation of heart contractility Arrhythmia: premature beat, atrial fibrillation irregular beat or long course

Cardiac neurosis Turbulence of sympathetic nerve & pneumogastric nerve Various symptom: palpitation, chest pain, tire, insomnia(失眠), headache, dizziness(眩晕) etc Usually seen in female Inducement: anxiety, excitement Diagnosis: cautious

Accompanying symptoms Palpitation with chest pain. It is often present in coronary heart disease (angina心绞痛, myocardial infarction), myocarditis(心肌炎), pericarditis(心包炎). It is also present in cardiac neurosis.

Accompanying symptoms Palpitation with fever. It is observed in acute infection, rheumatic fever(风湿热), myocarditis, pericarditis, infective endocarditis(感染性心内膜炎).

Accompanying symptoms Palpitation with syncope(晕厥) or twitch(抽搐). It is present in high-degree AVB, ventricular fibrillation(室颤), paroxysmal ventricular tachycardia, SSS.

Accompanying symptoms Palpitation with anemia. It happens after acute hemorrhage, which accompanys with sweat, hypotension, shock. Palpitation with weight loss and sweating. It suggests Thyrotoxicosis.

小结 心悸的病因 心脏搏动增强 心律失常 心脏神经官能症

心脏搏动增强的原因 生理性者 剧烈运动、过度紧张、烈性饮料、药物 病理性者 心室肥大、甲亢、贫血、发热、低血糖

心律失常引起心悸的原因 心率快 心率慢 心脏搏动不规则

复习思考题 不是心悸原因的是 A.心肌收缩力减弱 B.心动过速 C.心动缓慢 D.期前收缩 E.心房颤动

引起心悸的病理因素是 A.应用阿托品 B.饮酒和喝浓茶、咖啡后 C.精神过度紧张 D.甲状腺功能亢进 E.以上都不是

关于心悸不正确的是 A.是自觉心脏跳动的不适感或心慌感 B.有心悸则一定有心脏病 C.心动过速或心动过缓均可引起心悸 D.自主神经功能紊乱可引起心悸 E.生理情况下也可出现心悸

X型题 引起心悸的左心室肥大性疾病有 A.高血压性心脏病 B.主动脉瓣关闭不全 C.二尖瓣关闭不全 D.期前收缩 E.心脏神经症

X型题 心悸伴晕厥可见于 A.高度房室传导阻滞 B.心室颤动 C.心肌炎 D.甲状腺功能亢进 E.病态窦房结综合征

X型题 心悸伴心动过速的有 A.窦性心动过速 B.心房颤动 C.期前收缩 D.阵发性室上性心动过速 E.阵发性室性心动过速

X型题 心悸伴心动过缓的有 A.高度房室传导阻滞 B.窦性心动过缓 C.病态窦房结综合征 D.甲状腺功能亢进 E.心房颤动