Palpitation medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]

The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.

• The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause.
• A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.
• Patients with no positive findings in their initial physical examination and 12 lead ECG may be discharged with the advice to follow up with a cardiologist. ^[1]
• Patients with documented arrythmias or worrying symptoms such as presyncope, syncope, chest pain, dyspnea or hemodynamic instability require further treatment.
• To elucidate the treatment of every underlying cause is beyond the scope of this chapter.
• Arrythmias may be treated with antiarrhythmics or invasive electrophysiologic management. ^[2]
  • Premature ventricular contractions may be treated with beta blockers, amiodarone or may be left alone if it is an isolated incident and the heart is structurally normal.
  • In general, ventricular and atrial ectopics are commonly benign and reassurance along with withdrawal of precipitants (caffeine, alcohol) is the best treatment in such cases.^[3]
• The treatment of atrial fibrillation and atrial flutter involves rate control, rhythm control and risk stratification for systemic anticoagulation.
  • Paroxysmal supraventricular tachycardias may be treated with vagal maneuvers, antiarrhythmics such as cardioselective beta blockers, adenosine or non dihydropyridine calcium channel blockers. Ablation and synchronized cardioversion are reserved for haemodynamically unstable patients.
  • Sustained ventricular tachycardias with high risk features like an ejection fraction < 40% , family history of sudden cardiac death or a past history of structural heart disease may be referred for an electrophysiology study or implantable cardioverter defibrillator placement.
  • Depending on the degree of heart block, treatment may include reassurance, antiarrhythmics or temporary/permanent pacing.
• Structural heart disease such as hypertrophic cardiomyopathy, severe valvular heart disease and congenital heart defects may be treated surgically.
• Antidotes, behavioral therapy and cessation of drug intake would be the treatment strategy employed for palpitations secondary to substance abuse.