-►Palpitations are extremely common among patients who present to their
internist and can best be defined as an intermittent "thumping,"
"pounding," or "fluttering" sensation in the chest. This sensation can
be either intermittent or sustained and either regular or irregular.
Most patients interpret palpitations as an unusual awareness of the
heartbeat, and become especially concerned when they sense that they have had "skipped" or "missing" heartbeats.
-►Palpitations are brought about by cardiac (43%), psychiatric (31%),
miscellaneous (10%), and unknown (16%) causes, according to one large
-►Among the cardiovascular causes are premature atrial
and ventricular contractions, supraventricular and ventricular
arrhythmias, mitral valve prolapse (with or without associated
arrhythmias), aortic insufficiency, atrial myxoma, and pulmonary
-►Psychiatric causes of palpitations include panic
attacks or disorders, anxiety states, and somatization, alone or in
combination. Patients with psychiatric causes for palpitations more
commonly report a longer duration of the sensation (>15 min) and
other accompanying symptoms than do patients with other causes.
Picture: Shows causes of first and second heart sound