Brief Answer:
Clinical examination by cardiologist required

Detailed Answer:
Hi
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Greetings of the day

Dear Mr XXXXXXX


Palpitations are extremely common among patients who present to their caregiver 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 heart beat and become especially concerned when they sense that they have had "skipped" or "missing" heart beats. Palpitations are often noted when the patient is quietly resting, during which time other stimuli are minimal. Palpitations that are positional may reflect a structural process within (e.g., atrial myxoma) or adjacent to (e.g., mediastinal mass) the heart.

Palpitations are brought about by
1. cardiac (43%)
2. psychiatric (31%)
3. miscellaneous (10%)
4. unknown (16%) causes

Cardiac causes include
1.premature atrial and ventricular contractions
2. supraventricular and ventricular arrhythmias
3 mitral valve prolapse
4. aortic regurgitation

Intermittent palpitations are commonly caused by premature atrial or ventricular contractions: the postextrasystolic beat is sensed by the patient owing to the increase in ventricular end-diastolic dimension following the pause in the cardiac cycle and the increased strength of contraction (postextrasystolic potentiation) of that beat.

Regular, sustained palpitations can be caused by regular supraventricular and ventricular tachycardias . Irregular, sustained palpitations can be caused by atrial fibrillation.

It is important to note that most arrhythmias are not associated with palpitations. In those that are, it is often useful either to ask the patient to "tap out" the rhythm of the palpitations or to take his or her pulse while palpitations are occurring. In general, hyperdynamic cardiovascular states caused by catecholaminergic stimulation from exercise, stress, or pheochromocytoma can lead to palpitations. In addition, the enlarged ventricle of aortic regurgitation and accompanying hyperdynamic precordium frequently lead to the sensation of palpitations.


Other factors that enhance the strength of myocardial contraction, including tobacco, caffeine, aminophylline, atropine, thyroxine, cocaine, and amphetamines, can cause palpitations.

Psychiatric causes of palpitations include panic attack or disorder, 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. Among the miscellaneous causes of palpitations are included thyrotoxicosis, drugs (see above) and ethanol, spontaneous skeletal muscle contractions of the chest wall, pheochromocytoma, and systemic mastocytosis.

Approach to the Patient: Palpitations

The principal goal in assessing patients with palpitations is to determine if the symptom is caused by a life-threatening arrhythmia. Patients with preexisting coronary artery disease (CAD) or risk factors for CAD are at greatest risk for ventricular arrhythmias as a cause for palpitations. In addition, the association of palpitations with other symptoms suggesting hemodynamic compromise, including syncope or lightheadedness, supports this diagnosis. Palpitations caused by sustained tachyarrhythmias in patients with CAD can be accompanied by angina pectoris or dyspnea. In patients with ventricular dysfunction (systolic or diastolic), aortic stenosis, hypertrophic cardiomyopathy, or mitral stenosis, with or without CAD, palpitations can be accompanied by dyspnea from increased left atrial and pulmonary capillary wedge pressure.

Key features of the physical examination that will help confirm or refute the presence of an arrhythmia as a cause for the palpitations and its adverse hemodynamic consequences include measurement of the vital signs and clinical assessment. A resting electrocardiogram can be used to document the arrhythmia. If exertion is known to induce the arrhythmia and accompanying palpitations, exercise electrocardiography can be used to make the diagnosis.

Most patients with palpitations do not have serious arrhythmias or underlying structural heart disease. Occasional benign atrial or ventricular premature contractions can often be managed with beta blocker therapy if sufficiently troubling to the patient. Palpitations incited by alcohol, tobacco, or illicit drugs need to be managed by abstention, while those caused by pharmacologic agents should be addressed by considering alternative therapies. Psychiatric causes of palpitations may benefit from cognitive or pharmacotherapies. The physician should note that palpitations are at the very least bothersome and, on occasion, frightening to the patient. Once serious causes for the symptom have been excluded, the patient should be reassured the palpitations will not adversely affect his or her prognosis.


I would suggest you to consult your Physician:

1. Thorough clinical examination
2. ECG along with long lead II
3. 2 D Echocardiography
4. Rule out anaemia as the cause


So there is no need to be stressed or anxious.

Take care

Best Regards
Dr T Shobha Deepak
MBBS,MD

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Brief Answer:
Propranolol is indicated

Detailed Answer:
Namasthe

As all your investigation are within normal limits , there is no cause for concern.
Your symptoms are likely to be due to anxiety and stress. It will definitely respond to Propranolol. So go ahead and take it.
Brisk walking and meditation will also be beneficial.

Take care

Best Regards
Dr T Shobha Deepak

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Brief Answer:
You can safely take it

Detailed Answer:
Namasthe

Do not worry Propranolol will not drastically bring done the blood pressure. Postural hypotension is not known with this drug. Propranolol acts by reducing the heart rate and slghtly reducing contractility of heart. It does not affect peripheral vascular resistance so there is no associated significant fall in blood pressure.

Nothing to worry, you can safely take it.

Take Care
Best Regards
Dr T Shobha

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