Heart Palpitations

HEART PALPITATIONS (palpitatio cordis, cardiac racing), subjective sensation of heart beating. The pathogenesis of heart palpitations is diverse and in many respects still not fully clarified. Heart palpitations appear either due to increased excitability of the sensory nervous system, both central and peripheral, or due to actual strengthening of heart contractions (Levin, Edens, and others). Centripetal impulses perceived as heart palpitations can be transmitted to the brain through various paths: through the vagus nerve, along the intercostal nerves, from the parietal pleura, from tissues of the mediastinum and chest cavity, shaken by heart contractions. Heart contractions during palpitations are usually accelerated and strengthened, however they can also be slowed, for example in sinus bradycardia, transverse atrioventricular block. According to duration as well as the nature of onset, two large groups of heart palpitations can be distinguished: prolonged heart palpitations and sporadic heart palpitations, appearing in the form of attacks lasting from several minutes to several days with longer or shorter intervals, for example in paroxysmal tachycardia (see). Types of heart palpitations. Physiological, often occurs after muscular work due to strengthened and accelerated heart activity at that time. It represents a manifestation of intensified heart work in the process of adaptation of the cardiovascular system to increased tissue needs for blood supply. In individuals with normal cardiovascular system, especially in trained individuals, heart palpitations, resp. tachycardia, occur only after prolonged or strenuous muscular work and disappear quickly, after 1-2 minutes after work. On the contrary, untrained individuals, easily excitable, with various deviations in the cardiovascular system react with heart palpitations and sometimes prolonged ones to insignificant physical exertion. In the presence of habituation to strengthened and accelerated heart activity, heart palpitations may not be felt. Pathological heart palpitations are observed in numerous diseases of the cardiovascular system (endocarditis, heart defects, myocardial damage, hypertension, etc.). Heart palpitations occurring after insignificant physical load often indicate beginning heart failure in compensated defects and myocardial damage. However, a direct dependence between the nature and severity of heart damage and heart palpitations cannot be established. Thus, in severe heart damage accompanied by accelerated activity of the heart, heart palpitations are often absent and, conversely, they are often sharply expressed in the absence of heart damage, for example in neurasthenics. Absence of heart palpitations in severe heart damage accompanied by tachycardia is obviously due to weakness of individual contractions. In a whole series of cases, when heart contraction is strengthened (in aortic valve insufficiency, hypertrophy in hypertension), heart palpitations may also be absent, which may be due to habituation of patients to intensified activity of the myocardium. In paroxysmal tachycardia, heart palpitations are usually observed, but in some cases, when cardiac activity is weakened, resp. in the presence of an alternating pulse, heart palpitations may be absent. Among the group of nervous heart palpitations, psychogenic heart palpitations in neurasthenics and individuals with unstable psyche should be mentioned first, occurring mainly during excitations or when attention is fixed on cardiac activity. Heart palpitations are often accompanied by tachycardia. Reflex heart palpitations are observed in diseases of various internal organs: cholecystitis, appendicitis, uterine diseases, high position of the diaphragm, etc. Finally, purely toxic heart palpitations occur with excessive use of coffee, tobacco. In Basedow's disease, heart palpitations are caused by excitation of the sympathetic nerve and direct influence of the thyroid gland's secretion on the heart. In anemias, heart palpitations with accelerated rhythm are also noted as a rule. Reflex, resp. nervous, heart palpitations are easily recognized in the absence of physical signs of heart damage. Heart palpitations should be distinguished from various unpleasant sensations from the heart observed in various cardiac rhythm disturbances. Heart stumbling, individual strong heart thrusts, sensation of heart stopping ('the heart fell somewhere', 'turned over') are observed mainly in extrasystoles and are due to change in the nature of contractions and compensatory pause. Frequent and slow heart contractions in the form of alternating strong and weak heart thrusts are observed in atrial fibrillation and flutter (see Atrial fibrillation, Heart arrhythmias). Sensation of heart stopping or heart freezing, dropping out of heart contraction can be false and true. False dropouts are observed in extrasystoles. True heart stops, objectively manifested as pulse dropout, occur in so-called sino-auricular block (see Heart block). Establishing these two forms of dropout is often possible when simultaneously listening to the heart and examining the pulse. In extrasystoles, extra tones or one tone are heard, while the pulse wave in the radial artery is not felt, being revealed only on the sphygmogram as a slight elevation. In sino-auricular block, extra tones are not heard at all. Electrocardiography in these cases best deciphers the nature of these sensations. Sensation of heart stopping is most often purely psychogenic. -- Treatment in heart diseases, besides treatment of the main condition, is purely symptomatic: cold is applied to the heart area, camphor bromide and bromine preparations (sedatives) are used. In nervous heart palpitations - psychohygiene and sedatives. In reflex and toxic heart palpitations - elimination of causes that caused them.