흉추 2,3,4 극돌기 통증... palpitation 심계항진, 가슴두근거림...

[문형철]

S Afr Fam Pract (2004)

. 2022 Feb 24;64(1):5449. doi: 10.4102/safp.v64i1.5449

Palpitations: Eval‎uation and management by primary care practitioners

Indiran Govender 1,✉, Kamelia K Nashed 1, Selvandran Rangiah 2, Sunday Okeke 3, Olga M Maphasha 4

• Author information
• Article notes
• Copyright and License information

PMCID: PMC8905373  PMID: 35261258

Abstract

Palpitations are a common, non-specific presenting complaint in primary healthcare and emergency departments. Palpitations are mostly a symptom of benign underlying disease but a sign of life-threatening conditions. Importantly, palpitations are a symptom and not a diagnosis, and cardiac causes are the most concerning aetiology. Clinicians should seek to identify the underlying cause. History and physical examination are important in the assessment of patients with palpitations, and the use of a 12-lead electrographic (ECG) monitor on presentation is the gold standard of diagnosis. If the aetiology cannot be determined, an ambulatory Holter 24–48-h monitor can be used. Treatment and follow-up of patients presenting with palpitations as the main complaint will depend on the aetiology and investigation findings. Patients with palpitations accompanied by dizziness, excessive fatigue, or chest pains should receive adequate acute care aiming to stabilise their condition before referring to a higher level of care.

요약
심계항진은 일차 의료기관과 응급실에서 흔히 나타나는 비특이적 증상입니다. 심계항진은 대부분 양성 기저 질환의 증상이나 생명을 위협하는 상태의 징후입니다. 중요한 것은 심계항진이 진단이 아니라 증상이라는 점이며, 심장 질환이 가장 우려되는 원인입니다. 임상의는 기저 원인을 파악해야 합니다. 심계항진 환자의 진단에는 병력 및 신체 검사가 중요하며, 진찰 시 12-리드 심전도(ECG) 모니터를 사용하는 것이 진단의 황금률입니다. 원인을 파악할 수 없는 경우에는 외래 홀터 24-48시간 모니터를 사용할 수 있습니다. 심계항진을 주 증상으로 하는 환자의 치료와 후속 조치는 병인 및 검사 결과에 따라 달라집니다. 어지러움, 과도한 피로, 또는 흉통을 동반한 심계항진 환자는 더 높은 수준의 치료를 받기 전에 상태를 안정시키는 것을 목표로 적절한 급성 치료를 받아야 합니다.

Keywords: palpitations, ECG, arrhythmia, chest pain, tachycardia

Introduction

Palpitations are defined as the awareness of abnormal heartbeat, rapid pulsation or irregular beating of the heart.1 They are often described by the patient as a rapid fluttering, skipping or pounding sensation in the chest or neck.1,2,3 The symptom may reflect a cardiac or non-cardiac cause or a high catecholamine state.4

Palpitations are a frequent symptom in the general population and one of the most common presentations to general practice.2,3,5 They are the second most common reason for primary healthcare referrals to cardiologists.3

Palpitations are associated with long-term morbidity with a substantial proportion of patients reporting concern and anxiety despite the exclusion of a significant underlying cause. The challenge at the primary healthcare level is differentiating palpitations of a benign aetiology from those related to a significant underlying arrhythmia that requires prompt treatment, investigations and referral.5,6

The diagnostic and therapeutic management of this symptom is challenging and can be frustrating for both the patient and the primary healthcare physician, as in many cases a definitive diagnosis of the cause of the palpitations is not reached and no specific therapy is initiated.6,7 Many patients will continue to suffer recurrences of their symptoms, which impairs their quality of life both mentally and physically, leading to the risk of adverse clinical events and recurrent visits to the healthcare facilities.

This article reviews the approach of a primary health care physician to patients presenting with palpitations.

소개

심계항진은

비정상적인 심장 박동,

빠른 맥박 또는 불규칙한 심장 박동을 느끼는 것으로

정의됩니다.1

환자들은

종종 가슴이나 목에 빠른 떨림, 펄럭임 또는

두근거림과 같은 느낌을 경험한다고 설명합니다.1,2,3

이 증상은

심장 또는

비심장 원인 또는

높은 카테콜아민 상태를 반영할 수 있습니다.4

심계항진은 일반 인구에서 자주 나타나는 증상이며,

일반 진료에서 가장 흔하게 나타나는 증상 중 하나입니다.2,3,5

심계항진은

1차 진료에서 심장 전문의를 찾는 두 번째로 가장 흔한 이유입니다.3

심계항진은 장기적인 이환율과 관련이 있으며,

상당수의 환자가 근본적인 원인을 배제한 상태임에도 불구하고

우려와 불안을 보고합니다.

1차 의료 수준에서 해결해야 할 과제는

양성 원인의 심계항진과 즉각적인 치료,

조사 및 의뢰가 필요한 심각한 기저부정맥과 관련된 심계항진을 구분하는 것입니다.5,6

이 증상의 진단 및 치료 관리는

까다롭고,

많은 경우 심계항진의 원인에 대한 명확한 진단이 이루어지지 않고

구체적인 치료가 시작되지 않기 때문에

환자와 주치의 모두에게 실망감을 안겨줄 수 있습니다.6,7

많은 환자들이 증상의 재발을 겪으며,

이로 인해 정신적, 육체적으로 삶의 질이 저하되고,

부작용이 발생할 위험이 있으며,

의료 시설을 다시 방문해야 하는 상황이 발생합니다.

이 글에서는

심계항진이 있는 환자를 대하는

일차 진료 의사의 접근 방식을 살펴봅니다.

Pathophysiology

The mechanisms responsible for the sensation of palpitations are incompletely understood.8 It has been suggested that the neural pathways responsible for the perception of the heartbeat include different structures located at the intracardiac and extracardiac levels.1 Palpations usually reflect changes in cardiac rate, rhythm or contractility, and abnormal movement of the heart is felt within the chest.3 The patient may be perceiving the augmented post-extrasystoles beat as the ‘skipped’ beat rather than the premature beat itself in case of isolated extrasystoles.9

The clinical perception of cardiac phenomena is highly variable. Awareness is heightened in sedentary, anxious or depressed patients and reduced in active, happy patients.9 Some patients can be aware of every premature ventricular beat, while others are unaware of even complex atrial or ventricular tachyarrhythmias. In some cases, palpations are perceived in the absence of any abnormal cardiac activity.9

병태 생리학

심계항진에 대한 메커니즘은 아직 완전히 밝혀지지 않았습니다.8 심장 박동을 인식하는 신경 경로에는 심장 내 및 심장 외 수준에 위치한 다양한 구조가 관여하는 것으로 알려져 있습니다.1 심계항진은 일반적으로 심장 박동수의 변화를 반영합니다. 리듬 또는 수축성, 그리고 비정상적인 심장 박동이 가슴 안에서 느껴집니다.3 환자는 분리된 심실성 빈맥의 경우, 심실성 빈맥이 증가하는 것을 조기 박동 자체가 아니라 '건너뛰어진' 박동으로 인식할 수 있습니다.9

심장 현상에 대한 임상적 인식은 매우 다양합니다.

앉아 있는 환자, 불안하거나 우울한 환자의 경우 인식이 높아지고,

활동적이고 행복한 환자의 경우 인식이 낮아집니다.9

어떤 환자는

모든 조기 심실 박동을 인식할 수 있는 반면,

다른 환자는 복잡한 심방 또는 심실 빈맥 부정맥조차 인식하지 못합니다.

어떤 경우에는 비정상적인 심장 활동이 없는 경우에도 촉진이 감지됩니다.9

Aetiology

Most palpitations are of cardiac origin, followed by psychiatric and miscellaneous causes such as thyrotoxicosis, caffeine, medication-induced, anaemia, cocaine and amphetamine. In some cases, it is difficult to determine the cause of palpitations.2,10

Some patients have heightened awareness of normal cardiac activity, particularly when exercise, febrile illness or anxiety increases the heart rate. However, most cases of palpitations result from arrhythmias. An arrhythmia is defined as any aberrant cardiac rhythm or beat. Arrhythmias range from benign to life-threatening.9,12 While arrhythmias often occur spontaneously in patients without serious underlying disorders, others can be caused by a serious cardiac disorder.9

The most common (and mostly benign) arrhythmias (Figure 311) include the following9:

원인

대부분의 심계항진은

심장병에 기인하며,

그 다음으로 정신병, 갑상선중독증, 카페인, 약물 복용, 빈혈, 코카인, 암페타민 등

기타 원인에 기인합니다.

어떤 경우에는 심계항진의 원인을 파악하기가 어렵습니다.2,10

일부 환자들은 정상적인 심장 활동에 대한 인식이 높아져 있습니다.

특히 운동, 발열성 질환, 불안 등이 심박수를 증가시킬 때 더욱 그렇습니다.

그러나

대부분의 심계항진은

부정맥으로 인해 발생합니다.

부정맥은 비정상적인 심장 박동 또는 박동으로 정의됩니다.

부정맥은 양성에서 생명을 위협하는 것까지 다양합니다.9,12

부정맥은 심각한 기저 질환이 없는 환자에서 자발적으로 발생하는 경우가 많지만,

심각한 심장 질환으로 인해 발생할 수도 있습니다.9

가장 흔한(그리고 대부분 양성인) 부정맥(그림 311)에는 다음이 포함됩니다9:

FIGURE 3.

Premature atrial contraction and premature ventricular contraction.

• • Premature atrial contractions (PACs)

  • Premature ventricular contractions (PVCs)

Other common arrhythmias include the following9:

• • Paroxysmal supraventricular tachycardia (PSVT)

  • Atrioventricular nodal re-entrant tachycardia

  • Atrial fibrillation or flutter

  • Ventricular tachycardia

  • Bradyarrhythmia’s and heart blocks

Life-threatening causes of palpitations are mostly of cardiac origin and include bradyarrhythmias or tachyarrhythmias. It can be because of atrial causes (e.g. atrial fibrillation or atrial flutter), ventricular causes (e.g. PVCs, ventricular tachycardia and ventricular fibrillation), high output states (e.g. anaemia, pregnancy, sepsis and hyperthyroidism), structural abnormalities (e.g. congenital heart disease, aortic aneurysm, cardiomegaly or acute left ventricular failure) and miscellaneous causes (e.g. postural orthostatic tachycardia syndrome [POTS]).1,3 POTS is a cardiovascular autonomic disorder characterised by orthostatic intolerance or inadequate cerebral perfusion on upright posture and is associated with a rapid increase in heart rate.9 In patients with orthostatic hypotension, because of an inadequate physiological response to postural changes in blood pressure, the systolic blood pressure decreases by 20 mmHg or the diastolic blood pressure decreases by 10 mmHg within 3 min of standing compared with blood pressure from the sitting or supine position. It commonly leads to palpations on standing.9 Ventricular tachycardia and supraventricular tachycardia may present with palpitations, dizziness and/or syncope.13

Metabolic conditions that can result in palpitations include hyperthyroidism, hypoglycaemia, hypocalcaemia, hyperkalaemia, hypokalaemia, hypermagnesaemia, hypomagnesaemia and pheochromocytoma.9

Anxiety disorders are another common cause of palpitations (Table 1). Information obtained from the patient’s history and family members assists in the diagnosis of anxiety disorder.11 Panic disorder is characterised by recurrent unexpected panic attacks. Panic disorder is more common in women of childbearing age.14 Environmental stressors may cause persistent palpitations in persons who are highly sensitive to bodily sensations.15

심장 박동으로 인한 생명을 위협하는 원인은 대부분 심장 기원에 있으며,

서맥성 부정맥 또는 빈맥성 부정맥을 포함합니다.

심방 원인(예: 심방 세동 또는 심방 조동),

심실 원인(예: PVC, 심실 빈맥 및 심실 세동),

고출력 상태(예: 빈혈, 임신, 패혈증 및 갑상선 기능 항진증),

구조적 이상(예: 선천성 심장병 대동맥류, 심비대, 급성 좌심실 부전) 및

기타 원인(예: 기립성 기립성 빈맥 증후군[POTS])이 있습니다.1,3

POTS는

기립성 빈맥 또는 기립 시 뇌관류 부족을 특징으로 하는

자율신경계 심장질환으로,

다음과 같은 증상과 관련이 있습니다.

심박수의 급격한 증가.9

기립성 저혈압 환자의 경우,

혈압의 자세 변화에 대한 생리적 반응이 부적절하기 때문에,

앉거나 누운 자세에서 혈압과 비교했을 때,

서 있는 지 3분 이내에 수축기 혈압이 20mmHg 감소하거나 이완기 혈압이 10mmHg 감소합니다.

이는 일반적으로 서 있을 때

두근거림을 유발합니다.9

심실 빈맥과 심실상 빈맥은 두근거림, 현기증 및/또는 실신으로 나타날 수 있습니다.13

두근거림을 유발할 수 있는 대사성 질환에는

갑상선기능항진증, 저혈당증, 저칼슘혈증, 고칼륨혈증, 저칼륨혈증, 고마그네슘혈증, 저마그네슘혈증, 갈색세포종이 있습니다.9

불안 장애는 두근거림의 또 다른 일반적인 원인입니다(표 1).

환자의 병력 및 가족 구성원으로부터 얻은 정보는 불안 장애의 진단에 도움이 됩니다.11

공황 장애는 예기치 않은 공황 발작이 반복적으로 나타나는 것이 특징입니다.

공황 장애는 가임기 여성에게서 더 흔하게 나타납니다.14

환경적 스트레스 요인은 신체 감각에 매우 민감한 사람에게 지속적인 두근거림을 유발할 수 있습니다.15

TABLE 1.

Types of palpitations.

Type of palpitationsSubjective descriptionHeartbeatOnset and terminationTrigger situationsPotential associated symptoms

Extrasystole	‘Skipping a beat’ ‘Heart sinking’	Irregular, interspersed with periods of a normal heartbeat	Sudden	Rest	-
Tachycardia	‘Beating wings’ in the chest	Regular or irregular, markedly accelerated	Sudden	Physical effort, cooling down	Hemodynamic impairment
Anxiety-related	Anxiety, agitation	Regular, slightly accelerated	Gradual	Stress, Anxiety attacks	Tingling in the hands and face, lump in the throat, atypical chest pain, sighing dyspnoea
Pulsation	Heart pounding	Regular, normal frequency	Gradual	Physical effort	Weakness and lack of strength

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Source: Adapted from Raviele A, Giada F, Bergfeldt L, et al. Management of patients with palpitations: A position paper from the European Heart Rhythm Association. Eurospace. 2011;13(7):920–934. https://doi.org/10.1093/europace/eur130.8

Certain drugs, including digitalis, caffeine, alcohol, nicotine and sympathomimetics (e.g. ibuterol, amphetamines, cocaine, dobutamine, adrenaline, ephedrine, noradrenaline and theophylline), frequently induce palpitations.

Most arrhythmias that cause palpitations have no direct adverse physiologic consequences of their own. However, bradyarrhythmias, tachyarrhythmias and heart blocks can be unpredictable and may adversely affect cardiac output and cause hypotension or death. Ventricular tachycardias, if left untreated, degenerate into ventricular fibrillation.15

Eval‎uation of a patient with palpitations

A complete history and a physical examination are essential to eval‎uate a patient with palpitations. Observations by other medical personnel or reliable observers should be sought.3,9

History

A thorough history is important as palpitations are subjective, and the majority of patients will present in sinus rhythm, between episodes of arrhythmia. It is important to clarify the nature of palpitations.3,9 Key questions in presenting complaints in history taking are as follows:

•  
•  
•  
•  
• • ■
  • ■
  • ■
  • ■

Systems review

Review of systems should cover symptoms of the causative disorder, including heat tolerance, weight loss and tremor (hyperthyroidism); chest pain and dyspnoea on exertion (cardiac ischemia); fatigue, weakness, heavy vaginal bleeding and dark tar-like stools (anaemia); and fatigue, excessive worry, irritability, difficulty in concentrating and sleep disturbances (anxiety disorder)1,9,16

Past medical history

The known potential causes, including documented arrhythmias and heart or thyroid disorders, should be identified. A history of all prescription and over-the-counter medications for example, nasal decongestants, herbal preparations and supplements, such as omega-3 polyunsaturated fatty acids, should be obtained.4 Medications used to treat attention-deficit/hyperactivity disorder and reliever inhalers for asthma may cause palpitations.3,17 The drug profile should be reviewed for offending prescription drugs (e.g. antiarrhythmics and digitalis).3

Family and social history

Occurrences of syncope or sudden death at an early age should be noted.9 The patient’s social history such as tobacco use, exercise habits, caffeine consumption (including tea and energy drinks), alcohol and illicit drug use should be explored.4

The presence of the following red flags should be considered as they increase the possibility of palpitations representing a serious cardiac rhythm disorder9:

• • Onset: sudden or gradual

  • Duration: momentary or sustained (how long?)

  • Frequency

  • Triggers

  • Associated symptoms:

    • ■

      Breathlessness

    • ■

      Chest pain

    • ■

      Dizziness

    • ■

      Syncope

•  
•  
•  
•  

ExaminationGeneral examination and vitals

The medical practitioner should note if an anxious demeanor or psychomotor agitation is present. Vital signs are reviewed for fever, hypertension or hypotension, tachycardia, bradycardia, tachypnoea or bradypnoea, and low oxygen saturation. Orthostatic changes in BP and heart rate should be measured.9

Peripheral examination

The examination should include inspection of the conjunctivae, palmar creases and buccal mucosa for pallor.9 Signs suggestive of hyperthyroidism, such as exophthalmos, thyroid enlargement or tenderness, should be sought.

Cardiac examination

Cardiac auscultation should note the rate and rhythm as well as any murmurs or extra heart sounds that might indicate underlying valvular or structural heart disease.9 However, the examination alone is an unreliable method to determine the arrhythmia causing the palpitations, but certain findings can suggest types of rhythms such as the unique irregular irregularity of some cases of rapid atrial fibrillation, the regular irregularity of coupled atrial or ventricular extrasystoles, the regular tachycardia at 150 beats/min of atrial flutter, which is rare with any other arrhythmia in adults, and the regular bradycardia of < 35 beats/min of complete atrioventricular block.

Examination of the jugular venous pulse waves is a useful and important element of the physical examination but clinically remains difficult for most practitioners to recognise and interpret (Figures 1 and 2).17

FIGURE 1.

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The jugular venous pressure measurement.

FIGURE 2.

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Jugular venous pressure waveform.

Neurological examination

Neurological examination should note whether resting tremors or brisk reflexes are present (suggesting excess sympathetic stimulation). An abnormal neurologic finding could suggest that seizures rather than a cardiac disorder may be the cause of syncope and is one of the symptoms.9

Diagnostic eval‎uation of patients with palpitatixxxxonsElectrocardiography eval‎uation

In all patients who complain of palpitations, a 12-lead electrocardiography (ECG) eval‎uation is appropriate at the time of symptoms. An ECG is a practical, non-invasive method of recording cardiac rhythm in primary healthcare. Unless the recording is done while symptoms are occurring, it may not provide a diagnosis. Many cardiac arrhythmias are intermittent and show no fixed ECG abnormalities; exceptions include the following:

•  
•  
•  
•  
•  

Tilt-table testing is a simple, non-invasive diagnostic tool for patients with syncope of unknown origin by inducing syncope.

If no diagnosis is apparent and symptoms are frequent, Holter monitoring, a portable version of an ECG for 24–48 h, is useful for intermittent symptoms, and an event recorder is worn for longer periods.6 These tests are used mainly when a sustained arrhythmia is suspected, rather than when symptoms suggest only occasional skipped beats.

Patients with occasional symptoms of palpitations, dizzy spells or syncope where clinicians suspect a serious arrhythmia may have a device implanted beneath the skin of the upper chest (implantable loop recorder [ILR]) by a specialist. The ILR can help diagnose heart rhythm problems that only happen occasionally by continuously recording the rhythm and heart rate and storing them in its memory.

In patients who have palpitations with physical exertion and patients with suspected coronary artery disease or myocardial ischemia, ECG stress testing is appropriate following specialist referral.3 Findings from the physical examination or ECG may suggest the need for echocardiography to eval‎uate structural abnormalities and ventricular function.

Laboratory testing

Laboratory testing should be limited in primary healthcare to full blood count assessing anaemia and infection, serum urea, creatinine and electrolytes assessing electrolytes and renal function. Thyroid function tests are indicated when atrial fibrillation is newly diagnosed or there are symptoms of hyperthyroidism.1,9

Cardiac markers (e.g. troponin and creatinine kinase) should be measured in patients with ongoing arrhythmias, chest discomfort or other symptoms, suggesting recent coronary ischemia, myocarditis or pericarditis.

Patients with findings suggesting cardiac dysfunction, structural heart disease or symptoms on exertion require stress testing, echocardiography and, sometimes, cardiac magnetic resonance imaging (MRI), nuclear scanning or positron emission tomography (PET) and will therefore need to be referred to a tertiary level hospital.9

Management of patients with palpitations

The underlying cause of palpitations determines management.1 Precipitating drugs and substances are stopped. If a necessary therapeutic drug causes dangerous or debilitating arrhythmias, a different agent should be tried.9 All patients with palpitations associated with red flags might need urgent care by the primary care practitioner and urgent referral to a specialist.

For isolated PACs and PVCs in patients without structural heart disease, simple reassurance and support are appropriate as they are thought to be benign. A medical practitioner should address common risk factors and triggers and promote lifestyle changes to lower stress, stop smoking, and cut back on caffeine and alcohol.1,9 For otherwise healthy patients in whom these phenomena are disabling, a β-blocker such as propranolol or metoprolol or calcium channel blocker such as verapamil can be given provided efforts are made to avoid reinforcing the perception of anxious patients who have a serious disorder.1,9 Educate select patients with a suspected or documented SVT regarding the use of the Valsalva manoeuvre used to terminate arrhythmias.3

Identified rhythm disturbances and underlying disorders are investigated and treated (Table 2).9

TABLE 2.

Some treatments for arrhythmias.

DisorderTreatment†

Narrow complex (≤ 120 ms): Tachycardias
Multifocal atrial tachycardia	Rate control: β-blockers (verapamil or diltiazem). (Adapted from https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.grepmed.com%2FimagFmultifocal-tachycardia-ecg-cardiology-diagnosis&psig.)
Atrial flutter
Atrial fibrillation	Mx: Stabilise using ABC, direct current (DC) cardioversion for unstable patients. Antiarrhythmic drugs may be given before cardioversion with an anticoagulant. For stable patients, rate control with β-blockers or calcium channel blockers and rhythm control with amiodarone can be used plus anticoagulant to prevent thromboembolism. The underlying cause must be identified and corrected.
Supraventricular tachycardia	Mx: Vagal stimulation, adenosine or verapamil, or diltiazem may be used. If failed or hemodynamic compromised, synchronised cardioversion is preferred.
Atrioventricular nodal re-entrant tachycardia	Mx: β-blockers (verapamil or diltiazem), catheter ablation if ineffective.
Wide QRS complex (≥ 120 ms): Tachycardias
Ventricular tachycardia	Stable, monomorphic VT: Mx: Identify and correct the underlying cause, synchronised cardioversion or anti-arrhythmic, such as amiodarone, sotalol and lidocaine, and once reversion to is sinus obtained, refer to cardiology for consideration for radio-ablation, implanted defibrillator (automated implantable cardiac defibrillator or pacemaker)
Torsade de pointes	A specific form of polymorphic ventricular tachycardia Mx: Magnesium, potassium, defibrillation, β-blocker, overdrive pacemaker, implanted defibrillator
Ventricular fibrillation, unstable VT	Mx: Defibrillation, β-blocker, amiodarone, lidocaine, implanted defibrillator
Brugada syndrome	DC, direct-current. DC, direct-current. Mx: Cardioversion, implanted defibrillator, look for underlying trigger (e.g. Infection) that unmasked Brugada

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Source: Adapted from Thompson A, Shea MJ. Palpitations [homepage on the Internet]. 2020. MSD Manual Profession ed. Available from: www.msdmanuals.com

Note: Vagal stimulation includes Valsalva manoeuvre, carotid massage, ice cold water to the face of a child. Vagal manoeuvres and adenosine injection may help in clinical diagnosis (narrow QRS [Long {or short} QT syndromes {LQTS}] tachycardia), particularly in situations in which the ECG during tachycardia is unclear.

†

, Always identity and correct causes and exacerbating factors (e.g. electrolyte abnormalities and hypoxemia, drugs).

Conclusion

Palpitation is a common symptom occurring in primary care settings. While most are benign, thorough history, examination and awareness of life-threatening conditions can reduce unnecessary referral, and judicious use of limited resources and ECG are essential to exclude serious conditions. Eval‎uation of a patient presenting with palpitations can be more manageable by understanding the causes and red flags. Standard 12-lead electrocardiography will guide further investigations.

Patients presenting with life-threatening conditions at primary care facilities require immediate intervention and management to stabilise their condition and urgent referral to a higher level of care.

Holter monitor, the portable ECG recording, is a useful tool for diagnosing the causes of occasional palpitations and underlying arrhythmias; it would be beneficial if it were made available in primary healthcare facilities.

Anxiety disorders are a relatively common cause of palpitations in the modern medicine era, and screening of psychiatric aetiology of palpitation should be part of the assessment.

AcknowledgementsCompeting interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors’ contributions

I.G., K.K.N., S.R., S.O. and O.M.M. contributed equally to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

Ethical considerations

This article followed all ethical standards for research without direct contact with human or animal subjects.

Funding information

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

Footnotes

How to cite this article: Govender I, Nashed KK, Rangiah S, Okeke S, Maphasha OM. Palpitations: Eval‎uation and management by primary care practitioners. S Afr Fam Pract. 2022;64(1), a5449. https://doi.org/10.4102/safp.v64i1.5449

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