palpitation-心悸英语课件

palpitation-心悸英语课件palpitation-心悸英语课件1ObjectiveDefinitionEtiologyandpathogenesisDifferentialdiagnosisDiagnosisManagementObjectiveDefinition2palpitation-心悸英语课件3palpitation-心悸英语课件4FEATURESUGGESTSHEARTMISSESANDTHUMPSECTOPICBEATSWORSEATRESTECTOPICBEATSVERYFASTREGULARSVT(supraventriculartachycardia)/VT(ventriculartachycardia)SUDDENONSETSVT/VTOFFSET

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VAGALMANOEUVRESSVTFASTANDIRREGULARAF(atrialfibrillation)andATRIALFLUTTERwithvaryingblockFORCEFULANDREGULAR–NOTFASTAWARENESSOFSINUSRHYTHM(ANXIETY)SEVEREDIZZINESSORSYNCOPEVTorBRADYARRHYTHMIASPRE-EXISTINGHEARTFAILUREVTFEATURESUGGESTSHEARTMISSESAN5CausesofPalpitationsCARDIAC43%PSYCHIATRIC31%MISCELLANEOUS10%UNKNOWN16%CausesofPalpitationsCARDIACP6CardiovascularCausesArrhythmiasPrematureatrialandventricularcontractionsSupraventricularandventriculararrhythmiasWPW(Wolff-Parkinson-White)syndromeAtrialfibrillationAtrialflutterwithvaryingblockBrady-arrhythmias:completeheartblockSick-sinussyndromeCardiovascularCausesArrhythmi7CardiovascularCausesNon-arrhythmiccardiaccausesMitralvalveprolapse(withorwithoutassociatedarrhythmias)AorticinsufficiencyAtrialmyxomaPulmonaryembolismCongenitalheartdiseasesSystemichypertensionPericarditisPacemakerinducedtachycardiaCardiovascularCausesNon-arrhy8PsychiatricCausesIncludePanicattacksAnxietystatesSomatizationPsychiatricCausesInclude9PsychiatricCausesFeatureAlongerdurationofsensation>15minMultiplicityofsymptomsCardiacevaluationstillmaybenecessaryinpatientswithsuspectedpanicdisorder.ArrhythmiccausesmustberuledoutbeforethediagnosisofanxietyorpanicdisorderPsychiatricCausesFeature10MiscellaneousCausesHyperkineticcirculatorystates:AnaemiaFeverThyrotoxicosisHypoglycemiaPhaeochromocytomaMiscellaneousCausesHyperkinet11MiscellaneousCausesDrugs:AminophyllineAtropineThyroxineTricyclicantidepressantsVasodilatorsDigitalisMiscellaneousCausesDrugs:12MiscellaneousCausesOthers:CaffeineCocaineAmphetaminesTobaccoEthanolMiscellaneousCausesOthers:13OthersSpontaneousskeletalmusclecontractionsofthechestwallSystemicmastocytosisPhysiologicalcausesExertionExcitementPregnancyNeurocirculatoryastheniaVaso-vagalattackOthersSpontaneousskeletalmus14APPROACHTOTHEPATIENTWITHPALPITATIONS“Principalgoalinassessingpatientswithpalpitationsistodetermineifthesymptomiscausedbyalifethreateningarrhythmia”APPROACHTOTHEPATIENTWITHP15HOWTOEVALUATEPALPITATIONSTEP1Ispalpitationcontinuousorintermittent?IntermittentP.arecommonlycausedbyprematureatrialorventricularcontractionsVentricularend-diastolicdimensionPost-extrasystolicpotentiationHOWTOEVALUATEPALPITATIONSTE16HOWTOEVALUATEPALPITATIONSTEP2Isheartbeatregularorirregular?Regular,sustainedpalpitationsSVT(supraventriculartachycardia)and/orVT

(ventriculartachycardia)Irregular,sustainedpalpitationsAtrialfibrillationHOWTOEVALUATEPALPITATIONSTE17HOWTOEVALUATEPALPITATIONSTEP3:Whatistheheartrate?STEP4:Doespalpitationsoccurindiscreteattacks?Isonsetabrupt?Whatcanterminateattacks?VentriculararrhythmiasareonsetsuddenlyHoldingbreathorvagalmanoeuvresdecreasepalpitationsinSVTHOWTOEVALUATEPALPITATIONSTE18STEP5Arethereanyassociatedsymptoms?Chestpain:ArrhythmogenicMI(myocardialinfarction)Dyspnea:HeartfailureduetoarrhythmiasSyncope:Lowcardiacoutputduringarrhythmias,hypoglycemia,phaeochromocytomaSweating:Anxiety,hypoglycemiaDiarrhoea:ThyrotoxicosisHOWTOEVALUATEPALPITATIONSTEP5HOWTOEVALUATEPALPITAT19STEP6:Arethereanyprecipitatingfactors?ExerciseStressAlcoholintakeDrugsSTEP7:Isthereahistoryofstructuralheartdisease?CoronaryheartdiseasesValvularheartdiseasesHOWTOEVALUATEPALPITATIONSTEP6:HOWTOEVALUATEPALPIT20PhysicalexaminationVitalsignsJugularvenouspressureandpulseAuscultationofthechestandprecordiumPhysicalexaminationVitalsign21ExaminationECGRestingECGExerciseECG24-hourECGExaminationECG22ExaminationExamination23OthersHolterLooprecordings(externalorimplantable)Mobilecardiacoutpatienttelemetry.EventrecorderExaminationOthersExamination24HoltermonitorHoltermonitor25ImplantablelooprecordersImplantablelooprecorders26MobilecardiacoutpatienttelemetryMobilecardiacoutpatienttele27ManagementinaNutshellRe-assuranceLifestylemodificationCorrectionofco-morbiddiseasesAnxiolyticsandBeta-blockersAnti-arr