How to Stop Heart Palpitations
Atrial fibrillation (AF) may manifest only as fatigue caused by impaired cardiac output or the patient may have no symptoms. Palpitations, shortness of breath or chest pain may occur, and syncope may infrequently accompany AF. Symptoms of myocardial ischemia and angina may be caused by the rapid ventricular rate. Paroxysmal AF may cause symptoms that abate and recur.
P-Adrenoceptor antagonists, such as propranolol (Inderal), have been widely used in the treatment of cardiovascular diseases (see Chapters 16 and 20). These p-blockers also are useful in some forms of anxiety, particularly those that are characterized by somatic symptoms or by performance anxiety (stage fright). There is general agreement that p-blockers can lessen the severity and perhaps prevent the appearance of many of the autonomic responses associated with anxiety. These symptoms include tremors, sweating, tachycardia, and palpitations.
The symptoms of cyanide poisoning begin with central nervous system stimulation followed by depression (faintness, headache, anxiety, and giddiness). These symptoms may mimic those of hypoxia however, cyanosis will not be present unless respiratory failure has occurred. Eventually nausea, ataxia, palpitations,
Although there are few systematic studies of the phenomenology of intermittent explosive disorder, there are numerous clinical reports of people with rage outbursts which are described as explosive, uncontrollable, unpremeditated, and brief, provoked by minor stimuli, and associated with various psychological and physical symptoms, especially changes in mood, awareness, and sympathetic arousal.(5) For example, of 27 subjects with DSM-IV intermittent explosive disorder,(6) all reported aggressive impulses or violent urges prior to their aggressive acts which were variously described as the 'need to attack', the 'need to defend oneself', the 'need to strike out', an 'adrenalin rush', 'seeing red', or the 'urge to kill someone'. Most subjects described tension with the impulses and relief that was sometimes pleasurable with the acts. Most subjects also reported that affective symptoms accompanied their aggressive episodes. The most common affective symptoms associated with the impulses...
Physiological arousal may also contribute to hypochondriasis.(63) Autonomic hyperactivity is associated with bodily symptoms, which the hypochondriacal person may attribute to serious disease (e.g. chest pain, palpitations). (64) Gramling et al.(65) observed physiological reactivity that distinguished hypochondriacal from non-hypochondriacal women. Hypochondriacal subjects had a higher heart rate (but a lower baseline heart rate) and lower hand temperature during a cold pressor test compared to non-hypochondriacal controls. These subjects terminated the test more frequently and rated it as more unpleasant than did controls.
Asthma is one of the classic 'psychosomatic diseases'. Emotional arousal causes changes in airway tone. The severity of an asthma attack is highly correlated with presence of major depressive disorder, panic attacks, and level of fear. Psycho-education, relaxation, biofeedback, and family therapy have each shown efficacy in the management of asthma 31 Particularly important in the management of asthma is education about the adverse effects of antiasthma medications, which include jitteriness, palpitations, and insomnia. These side-effects may require treatment with behavioural and or psychopharmacological therapies.
Some patients suffer from intrusive thoughts or brooding related to their uncertainties regarding health, the future, the risk of contagion to others (especially loved ones), and the idea of death. The vegetative symptoms of panic attacks are also usually present (e.g. palpitations, dry mouth, hot flush, trembling, pressure in the chest, epigastric disturbance). In more severe cases, the patient may also present social isolation, verbal expressions of rage or feelings of desperation, and other forms of altered behaviour. These symptoms tend to appear within a few minutes to a few hours after the subject is informed, and remit in 2 or 3 days.
Anxiety states are accompanied by many different bodily symptoms, some of which are mediated by the sympathetic nervous system. In particular, palpitations, tremor, and gastrointestinal upset are related to the overactivity of b-adrenergic pathways. Consequently, blockade of this activity by means of b-adrenoceptor antagonists may help patients with anxiety, but usually only those complaining of the symptoms mentioned above. (49 In appropriate patients, a test dose, say 20 mg of propranolol, should be administered to detect undue sensitivity of the patient, as shown by a bradycardia below 60 beats min at rest. If no sensitivity is found, the dose can be instituted at 20 mg four times daily and increased over the course of a week or two to 40 mg four times daily.
In early cardiac disease, when the cumulative extent of myocardial damage is small (stage IA and IB), ventricular abnormalities are minimal or absent and the ECG is normal. These patients are typically asymptomatic and have a good prognosis. When myocardial damage is more advanced (stage II), areas of abnormal wall motion may be evident and conduction abnormalities usually are present due to lesions within the His-Purkinje system. In such patients, global ventricular function is preserved, but sudden cardiac death or complete atrioventricular block may develop. Nonspecific symptoms such as chronic fatigue, weakness, palpitations, and chest pain133 may be present. Such chest pain is vague and atypical of myocardial ischemia, but it sometimes prompts diagnostic evaluation. When the extent of myocardial damage is severe (stage III), the disease manifests as myocardial dysfunction that may be segmental, typically a ventricular aneurysm, or global, resembling a dilated cardiomyopathy. The...
Treatment of hyperthyroidism is directed at reducing the excessive synthesis and secretion of thyroid hormones. This may be accomplished by inhibiting thy-roidal synthesis and secretion with antithyroid drugs, by reducing the amount of functional thyroid tissue, or by both. Unfortunately, only a small proportion of patients treated with antithyroid drugs obtain long-term remission of their hyperthyroidism. Ablative therapy is often necessary. Since many of the signs and symptoms of hy-perthyroidism reflect increased cellular sensitivity to adrenergic stimulation, a p-adrenergic antagonist is often used adjunctively. Propranolol (Inderal), the most widely used p-adrenoceptor blocker, is effective in ameliorating many of the manifestations of thyrotoxicosis. It may reduce thyrotoxicosis-induced tachycardia, palpitations, tremor, sweating, heat intolerance, and anxiety, which are largely mediated through the adrenergic nervous system. Propranolol may also impair the conversion of T4 to...
The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathies and heart failure. The diagnostic dilemma is that some of the early symptoms of PPCM may mimic features of normal pregnancy such as increasing dyspnea on exercise, fatigue, and peripheral edema. Many pregnant women with no left ventricular dysfunction also have dyspnea on exertion and peripheral edema. Less common symptoms are chest and abdominal pain, palpitations, hemoptysis, or neurologic deficits due to car-dioembolic phenomena. Physical examination at the time of diagnosis may show jugular venous distension, resting tachycardia, hypotension, ventricular gallop rhythm, mitral regurgitation murmur, hepatosplenomegaly, ascites, and peripheral edema. The presentation is similar in patients presenting before and after delivery. Most patients present in New York Heart Association class III or IV heart failure. Patients may also present with palpitation without clinical evidence...
The phenomenon of safety behaviour, which appears to be functionally equivalent to avoidance and escape, may be relevant here. Once the feared situation is encountered and the patient believes harm is about to occur, he or she may try to prevent this. For instance, panic patients may sit down and try to relax in order to prevent cardiac failure. The non-occurrence of a heart problem may then be attributed not to the harmlessness of palpitations, but to the effectiveness of sitting down and relaxing. The rituals by which obsessive-compulsive patients respond to intrusions seem to serve the same function predicted harm is prevented by some safety operation.
Apart from beliefs about the outside world and others, a number of psychiatric disorders appear to be characterized by problematic beliefs about the self in general or about specific internal events. Generalized beliefs about the self being worthless and vulnerable are found in depression and borderline personality disorder.(106) Panic patients firmly belief that specific benign bodily sensations such as palpitations predict imminent catastrophes (e.g. cardiac infarction). (108) Interestingly, the paroxysmal occurrence of the sensations feared by panic patients is highly prevalent in the general population. (10.9) The crucial difference between such non-clinical and clinical panic is that non-clinical panickers are far less inclined to believe, during the attacks, that they may die from suffocation, have a cardial arrest, lose consciousness, and so on 110) Remarkably, phobics appear to expect similar catastrophic consequences of experiencing fear and related bodily sensations during...
Amphetamines, analeptics, and anorexiants stimulate the release of the neuro-transmitters norepinephrine and dopamine from the brain and from the peripheral nerve terminals of the sympathetic nervous system. The result is euphoria and increased alertness. The patient can also experience sleeplessness, restlessness, tremors, and irritability cardiovascular problems (increased heart rate, palpitations, dysrhythmias and hypertension). Some examples of anorexiants and
Ability to stimulate (2-receptors elsewhere in the body (see Chapter 2). The side effects include palpitations, tremor, nausea, vomiting, nervousness, anxiety, chest pain, shortness of breath, hyperglycemia, hypokalemia, and hypotension. Serious complications of drug therapy are pulmonary edema, cardiac insufficiency, arrhythmias, myocardial ischemia, and maternal death.
The most common side effect associated with insulin therapy is hypoglycemia, which may result in such CNS symptoms as tremors, lethargy, hunger, confusion, motor and sensory deficits, seizures, and unconsciousness. Adrenergic manifestations include anxiety, palpitations, tachycardia, and diaphoresis. In many cases, diabetics are aware that hypoglycemia is developing, and prompt administration of oral carbohydrates (e.g., fruit juice or glucose tablets) can restore normoglycemia. In more severe cases (e.g., unconsciousness, seizures), intravenous glucose or intramuscular glucagon is required to reverse the hypoglycemia.
Chest pain precipitated by exercise should be taken seriously (suggesting cardiac disease or, more commonly, exercise-induced asthma). History of trauma, rough play, or choking on a foreign body may be relevant. Chest pain associated with syncope or palpitations is more significant and may also relate to cardiac disease. History of fever suggests an infectious process (eg, pneumonia, myocarditis). 2. Arrhythmia. Associated with palpitations or abnormal cardiac exam. Supraventricular tachycardia is the most common of these arrhythmias, but premature ventricular contractions can also lead to brief, sharp chest pain.
Panic disorder is characterized by a fear of an immediately impending internal disaster (for example heart attack, cessation of breathing, mental derangement) and a sense of loss of control over physical and mental functions. Many of panic patients' negative thoughts can be viewed as misinterpretations of normal bodily sensations (such as palpitations or a slight feeling of breathlessness). Indeed, cognitive theorists (8.,9) argue that panic attacks result from a vicious circle in which catastrophic misinterpretations of body sensations lead to an increase in anxiety and associated sensations, which are in turn interpreted as further evidence of impending, internal disasters (e.g. heart attack, fainting, going mad). Panic disorder with agoraphobia is often also accompanied by fear of the interpersonal consequences of attacks (e.g. 'I'll make a fool of myself').
Amongst other neuroglycopenic manifestations, seizures or intermittent behavioural disturbances may occur. A rapid fall of blood sugar is associated with symptoms of catecholamine release, e.g. palpitations, sweating, etc. In 'atypical' seizures exclude a metabolic cause by blood sugar estimation when symptomatic. EPISODIC CONFUSION
Graves' disease or thyrotoxicosis is the most common type of hyperthyroidism and is caused by a hyperfunctioning thyroid gland. Graves' disease is characterized by a rapid pulse (tachycardia), palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exopthalmos (bulging eyes), and weight loss. Treatment involves surgical removal of a portion of the thyroid gland (subtotal thyroidectomy), radioactive iodine therapy, or antithyroid drugs that inhibit either the synthesis or the release of thyroid hormones.
Ephedrine and Ephedra alkaloids, alone and especially when combined with caffeine or caffeine-containing herbs, have been repeatedly demonstrated to promote a modest but significant short-term weight loss (approximately 0.9 kg month more than placebo, without caloric restriction) in human trials, as concluded in a recent meta-analysis.163 This meta-analysis also concluded, however, that the intake is associated with a 2.2- to 3.6-fold increase in the likelihood of psychiatric, autonomic or gastrointestinal symptoms, and heart palpitations.163 Some authors consider that the benefits of mixtures of ephedrine and caffeine in treating obesity may outweigh the associated risks, because side effects, when the products are used under controlled conditions, are usually mild and transient.164 1 65 However, individual susceptibility to adverse effects associated with the consumption of combinations of ephedrine and caffeine cannot be ignored similarly, it is essential not to ignore the fact...
Allergies to the local anesthetics are rare and are usually specific to ester-type agents. These allergic patients can usually be given amide-type agents because cross-reactivity between local anesthetics is rare. A true history of allergy will include the development of hives, wheezing, cardiac arrest, or shock. Most patients who claim a local allergy often have really had an adverse reaction. Symptoms of palpitations and nervousness may be a response to an additive such as Paraben or epinephrine. Patients may be describing the sequelae of inadvertent intervascular injections (4).
Because they increase the force of the heartbeat, all three catecholamines may produce an excessively rapid heart rate. Palpitations produced by epinephrine and isoproterenol are accompanied by tachycardia, whereas those produced by norepinephrine usually are accompanied by bradycardia owing to reflex slowing of the heart. Headache and tremor are also common. Epinephrine is especially likely to produce anxiety, fear, and nervousness.
In general, the patient population that requires dobutamine stress is a more selected and sicker population. It is important that the patient is warned about possible side effects of dobutamine infusion. The increase in heart rate and palpitations are often experienced as unpleasant (see Table 5-3).
Flumazenil rapidly reverses central nervous system and respiratory depression. Arousal usually occurs 30 to 60 s after intravenous administration and may last for 1 to 2 h. The rate of gradual relapse of sedation depends on the substances involved and their metabolites. Slow injection is recommended because of the frequent side-effects associated with sudden arousal, including anxiety, palpitations, nausea, and vomiting. Measures to prevent aspiration (lateral position, suction equipment) must be taken. The usual dose consists of 0.1 to 0.2 mg min every 30 s until sufficient alertness and adequate respiration and reflexes are obtained full recovery
Anagrelide is an oral imidazoquinazolin derivative that can be used to control the platelet count in patients with an MPD, including PV.121 Its mechanism of action is unclear but it appears to reduce the platelet count by suppressing the maturation of megakaryocytes and also suppresses the Hb levels by 1 to 2 g L in a proportion of patients with ET. It has no effect on the peripheral leukocyte count. Reported side effects of anagre-lide relate to its inhibition of phosphodiesterase and consequent positive inotropic and vasodilator effects with transient headache, palpitations, and fluid retention being common.
Most patients with panic disorder experience at least one sleep-related panic attack, and one-third or more of patients have recurrent nocturnal panic attacks. (2D Data from the few sleep panic attacks that have been recorded suggests that they occur more commonly during NREM sleep, at the transition to SWS. (22,23,) Symptoms of sleep panic attacks are essentially the same as those which occur during daytime attacks. Typically, patients report waking in a state of intense fear or anxiety, commonly with palpitations, shortness of breath, choking sensation, chest discomfort, and chills or hot flushes. They do not usually report dreaming just before the attacks. Unlike night terrors, which are characterized by incomplete arousal from sleep, patients having a sleep panic attack are awake and alert immediately after the attack begins. Patients with frequent sleep panic attacks may become fearful of going to sleep, which can contribute further to their insomnia.
The most frequent clinical manifestations of hyperthyroidism are nervousness, diaphoresis, hypersensitivity to heat, palpitations, fatigue, weight loss, tachycardia, dyspnoea, and weakness 6.8) The most common causes include Graves' disease, toxic adenoma, and toxic multinodular goitre. (69 Less common causes include Hashimoto's thyroiditis, postpartum hyperthyroidism, and factitious hyperthyroid state.
Adreno-medullary tumours (phaeochromocytomas) tend to present at a younger age when associated with the MEN syndrome, whereas sporadic tumours tend to occur in older patients. Classical symptoms include paroxysmal headaches, palpitations, tremors, and sweating attacks. A few may be diagnosed incidentally and a rare, but occasional case may be diagnosed after a maternal death in an unrecognized MEN family. Intermittent, severe hypertension is a rare but classical presentation.
Another serious toxic side-effect is the interaction of MAOIs and foods that are high in tyramine and other monoamines. Many of the foods that should be restricted in the diet of patients taking MAOIs are listed in T.a.bIe Z Tyramine has both direct and indirect sympathomimetic actions. The reaction usually develops 20 min to 1 h following ingestion of food and is characterized by nausea, apprehension, occasional chills, sweating, restlessness and hypotension with occipital headache, palpitations, and possibly vomiting. Neck stiffness, piloerection, dilated pupils, fever, and motor agitation are seen on examination. In severe forms the reaction can lead to delirium, hyperpyrexia, cerebral hemorrhage, and death. The interaction of the irreversible MAOIs with certain dietary components leading to the hypertensive reaction is one of the most serious drawbacks to the use of these types of compounds. The reversible MAOIs moclobomide and brofaromine have not been found to interact with...
Amitriptyline is a tricyclic antidepressant, which can be used for pain management. Pain modulation seems to be the result of decreased serotonin and norepinephrine reuptake in the central nervous system. It stabilizes mast cells and has a moderate anticholinergic effect. Amitriptyline may improve the IC symptoms in 64 to 90 of patients.44 Amitriptyline works better for patients with a substantial pain component to their symptoms and anesthetic bladder capacity greater than 600 mL.45 The starting dose is 10 to 25mg at suppertime, and may be increased on a weekly basis to 75 to 100mg,but the lowest dosage often results in satisfactory improvement. The side effects of amitriptyline may include weight gain, fatigue, decreased libido and ability to achieve orgasm, palpitations, and anticholinergic side effects. It may also affect thyroid function. Hepatotox-icity and bone marrow suppression can rarely occur.
It is becoming increasingly well recognized that respiratory dysfunction may be part of motor fluctuations accompanying long-duration PD. Forty percent of patients with fluctuations experience dyspnea tied to their motor state, primarily as an off' phenomena.57 Stridor is relatively common during the off period.58 Coughing may be seen. Advanced patients may report panic attacks that correlate with severity of motor fluctuations.59 At least part of this syndrome may be related to the sudden appearance of chest wall tightness and upper airway restriction with the associated anxiety, choking sensations, and palpitations that may accompany these physical symptoms. Additionally, dyskinesia may effect the respiratory system leading to shallow, uncoordinated breathing, which results in shortness of breath.60-62 Awareness of these entities is important, since an older patient complaining of chest tightness and shortness of breath invariably prompts and evaluation for cardiac and pulmonary...
Pheochromocytoma is a rare tumor of the sympathetic nervous system which produces characteristic symptoms of headache, sweating, diaphoresis and palpitations caused by catecholamine overproduction. Usually they present as unilateral intra-adrenal tumors, but bilateral tumors, extra-adrenal or pediatric presentations and metastatic spread occur in about 10 of patients. The diagnostic screening tool is measurement of urinary catecholamines or metanephrines while CT or ultrasound will define the presence of a mass.
Anagrelide The oral agent anagrelide was unexpectedly found to specifically reduce platelet counts by inhibiting megakary-ocyte platelet budding and is active in 95 percent of patients. It is not expected to have neoplastic potential. Its convenience and probable long-term advantages are now becoming attractive, especially for younger patients. Its use in older patients with ischemic heart disease or cardiac failure is discouraged. Other side effects caused by the drug's vasodilatory action (headaches, diarrhea) and positive inotropic action (palpitations) are usu
Inhalation is used to deliver antibiotics, steroids and mucolytic agents (drugs that thin secretions making it easier to clear the bronchi). The patient can experience side effects such as tremors, nausea, tachycardia, palpitations, nervousness, and dysrhythmias (see Chapter 14).
Internal tremors, the subjective experience of rhythmic truncal vibrations in the absence of visible tremor, occur in PD patients only some of whom also have visible limb tremors.2 Internal tremors appear to be distinct from palpitations, and while anxiety is common in these patients, the symptom is not likely a somatic manifestation of anxiety anxious people who do not have PD do not describe it in terms of a tremor inside the trunk.
Other a-adrenoceptor receptor antagonists include yohimbine, phenoxybenzamine, and thymoxamine. Yo-himbine is an a2-adrenoceptor antagonist, and thymox-amine is a competitive and relatively selective blocking agent for a1- adrenoceptors. Phenoxybenzamine blocks both a1- and a2-adrenoreceptors, although it has a greater affinity for the a1-subtype. All three of these a-receptor blocking drugs can induce penile erection, but their effects are generally less consistent and less effective than those of phentolamine. Yohimbine is only moderately effective in treating patients with organic impotence, and side effects may include postural hypotension, heart palpitations, fine tremors, and cavernosal fibrosis, especially following intracavernosal injections.
The toxicity of Astragalus membranaceus is very low oral doses of 75 to 100 g kg did not cause acute toxicity in mice.40 Although side effects are minimal at normal doses, higher doses of Astragalus (and many of the other herbal immunostimulants discussed here) may cause insomnia, increased heart rate, palpitations, hypertension, a general feeling of overstimulation, or all of these.