#MRCP#PACES#PLAB#USMLE#MEDICAL HISTORY#PRESENTING COMPLAINT#palpitations # racing of heart #arrhythmia


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Lets learn,how to differentiate among different causes of palpitations by asking simple questions:
P3MAFTOSA

Character of the palpitations
At this point we will take detail history of Characters of the palpitations including nature,
Rate and rhythm


Nature of palpitations:
What do the palpitations feel like?

Racing or tapping heart: suggesting a fast arrhythmia.
Missed or extra beats followed by a Pounding or more forceful beat: are suggestive of ventricular ectopic beats.
Pounding in the neck or everything stopped for a moment: may indicates of atrio-ventricular dissociation or bradycardia.
Regarding the explanation of this phenomenon:
The pounding feeling in the neck is due to cannon A waves which suggest atrial contraction against closed atrio-ventricular valves.
Whereas,
Rapid and regular pounding in the neck is most typical of re-entrant supraventricular arrhythmias particularly atrioventricular nodal re-entry tachycardia (AVNRT).

Rate and rhythm

Are the palpitations fast or slow? Do you take your pulse at that time? If so, what was it?
Are the palpitations regular?

Rapid, regular palpitations suggest sinus tachycardia, supraventricular tachycardia, and ventricular tachycardia. However, Irregular palpitations are suggestive of atrial fibrillation and extra-systoles.

Associated symptoms:

Age may provide a significant clue towards the diagnosis:

As, supraventricular tachycardia usually cause palpitations in young patient
Whereas, atrial fibrillation is more common in patient, older than sixty five year of age.
And,
Congenital long Q.T. syndrome may present in childhood and adolescence.

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