Palpitation natural history, complications and prognosis

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

Patient often present with a flip-flopping, fluttering, pounding or thud like sensation in one particular area or all over the precordium. It may or may not be associated with symptoms such as chest pain, dyspnea, presyncope, syncope or haemodynamic compromise. Complications include impairment of quality of life, hypotension, ventricular fibrillation and sudden cardiac death. Prognosis depends on the underlying cause but is generally good.

• Palpitations may present during one’s childhood or in the elderly as a flip-flopping, fluttering, pounding or thud like sensation in one particular area of the chest or all over the precordium.
• It may be regular or irregular, sustained or momentary and may be associated with symptoms such as chest pain, breathlessness, pedal edema, polyuria or signs of haemodynamic instability.

• Patients presenting with palpitations generally have a good prognosis (especially in the absence of a cardiac condition), but data regarding this is scarce. ^[1]
• However, associated symptoms play a major role in whether one should ‘worry’ or not.
  • Positive ECG findings, frequent or persistent palpitations, positive family history (sudden cardiac death, myopathy or cardiac condition) and symptoms such as presyncope, syncope, dyspnea and chest pain would require specialist referral.^[2]
• In a study conducted by Weber and Kapoor, a one year mortality rate of 1.6% was noted despite a high incidence of cardiac conditions. ^[3]
  • In the same study, a large number of patients experienced a significant impact on their quality of life in terms of their work capacity, and ability to perform household chores
• Barsky et al. confirmed these findings when they noted a low one year mortality rate but increased incidence of anxiety in individuals with palpitations, increased frequency of visits to the emergency department and therefore a decrease in the patient’s quality of life.• ^[4]
• Other complications that arise due to the underlying arrhythmia include hypotension, ventricular fibrillation,congestive heart failure ,acute pulmonary edema and sudden cardiac death.

• Prognosis depends on the underlying cause but is generally good.