How to Stop Heart Palpitations
In a study of four families carrying a DSP mutation, Bauce et al. found 26 mutations carriers 20 . Of these, 14 (54 ) fulfilled the established diagnostic criteria of ARVC D 21 , while 12 patients did not, although five of them had some cardiac abnormalities (Fig. 3.4). The clinical presentation included palpitations in six cases, sudden death in three, syncope in one. Two patients had chest pain with ECG abnormalities and increased myocardial enzymes. The coronary arteries were normal by angiography in both. No skin and hair abnormalities were found at physical examination. a range of 11 to 63 years 7 . The clinical data showed that the first symptom consisted of sustained VT in three patients, palpitations in three, and chest pain with increased serum markers of my-ocardial necrosis in presence of angiographically normal coronary arteries in one the remaining patient was asymptomatic. In addition, skin and hair were normal in all. There was a significant difference in the mean age...
Usually not associated with an increased arrhythmic risk and therefore do not require specific antiarrhythmic treatment. In many cases, reassurance of the patient results in an improvement of symptoms. However, should a patient still have severe symptoms due to palpitations, treatment with conventional -blockers or verapamil may be considered. -blockers appear to be more effective in patients with exercise-provocable ventricular arrhythmias, whereas verapamil may be more successful for the treatment of arrhythmias that occur at rest and are suppressed during exercise. Specific antiarrhythmic drugs or catheter ablation should be limited to patients with significant symptoms refractory to these measures.
The symptoms of episodic hypoglycaemia may be suggestive of CNS disease, hysteria, epilepsy, sympathetic overactivity, behavioural problems, or intoxication. Patients may complain of sweating, hunger, palpitations, or exhibit various focal neurological deficits coinciding with cerebral hypoglycaemia. Symptoms are either spontaneous, or induced by an overnight fast, or a controlled insulin infusion.They frequently occur before breakfast, or during vigorous exercise. In a study of 25 patients, the median time of severe symptoms of cerebral hypoglycaemia was 2 years and one-third of patients had had hypoglycaemic seizures (Doherty et al 1991). Hypoglycaemia may also occur in pregnancy or postpartum. One patient was found to be comatose on the second morning after delivery (Garner & Tsang 1989). Another was found confused, hypothermic (31.3 C), and sweating at 33 weeks' gestation, with a blood sugar of 0.8 mmol l-1. Difficulty was experienced maintaining her blood sugar because she had...
The symptoms in patients with insulinoma are attributable to the actions of two hormones insulin and catecholamines. Epinephrine and other cate-cholamines are secreted in response to low blood glucose levels. The signs and symptoms of hypoglycemia depend on the severity and duration of hypoglycemia. If the decrease in blood glucose is rapid, the auto-nomic nervous system is activated to release epineph-rine, which causes sweating, nervousness, tremor, palpitations, hunger, and pallor. The release of epi-nephrine is a compensatory response, which is used to increase blood glucose levels by enhancing the breakdown of hepatic glycogen to glucose.
Most adult patients have paroxysmal symptoms, lasting minutes to hours, consisting of headache (80 ), perspiration (70 ), and palpitations (60 ) other symptoms are commonly present, such as anxiety (50 ), a sense of dread, tremor (40 , with epi-nephrine-secreting tumors), or paresthesias. Recurrent chest discomfort, abdominal pain, and vomiting are also frequent symptoms. The abdominal pain may be caused by ischemic enterocolitis. Sweating (initially palms, head, and shoulders) usually occurs. Drenching sweats can occur, even in a cool environment, usually as an attack subsides. The reflex eccrine sweating that occurs later in an attack is ther-
In this study only two patients had an ICD before ablation. However, ICD was frequently implanted after the ablation or during the follow-up in order to protect the patient because of disease progression leading to new episodes of rapid VT or VF. Therefore ICD implantation was performed in nine patients. All patients with ICD had follow-up every 6 months. VTs were detected in the two exceptional patients and led to rehospitalizations. One patient had well tolerated asymptomatic VT interrupted by antitachycardia pacing (ATP), followed by two appropriate shocks in December, 2005, several VT episodes, and one appropriate shock in early 2006. Since then the patient has not had recurrent VT. Two patients had nonsustained VT. Three patients received inappropriate shocks. One patient had palpitations but no recording of VT by the device.
Anxiety is characterized by excessive and unjustified apprehension, feelings of foreboding, and thoughts of impending doom. Patients are tense and irritable, and frequently exhibit autonomic disturbances including sweating, palpitations, gastrointestinal distress, and shortness of breath. Both low-grade, free-floating anxiety and acute and intense panic attacks may occur.
Ventricular arrhythmias manifest clinically with palpitations, or episodes of ventricular tachycardia (VT) associated with syncope, and are frequently the first manifestations of the disorder. There is evidence that ARVC D is a common cause of sudden cardiac death in young people 6 . Patients with VT who have associated hemodynamics impairment or those who had ventricular fibrillation have a worse prognosis than patients with hemodynamically stable VT 7 . They usually also have more advanced right ventricular disease, as described by Turrini et al. 7 who demonstrated the association between sustained VT and reduced RV ejection fraction.
Kim et al. 54 reported a case of catheter ablation ofVT performed in a patient with dilated cardiomyopathy and a long history of repetitive palpitations. VT with LBBB with inferior axis morphology was present for about one third of the daytime hours. During electrophysiological study VT was reproduced by isoproterenol infusion and radiofrequency catheter ablation in the RVOT was performed. Left ventricular ejection fraction improved from 38 to 48 1 month after ablation, and to 61 1 year after ablation. In the series of Grimm et al. 55 , radiofrequency catheter ablation was performed in four adults with myocardial dysfunction related to RMVT originating in the RVOT. Serial echocardiographic assessment of LV function before and after radiofrequency catheter ablation of RMVT showed complete reversal of LV dysfunction without arrhythmia recurrence during a mean follow-up of 31 months. In the study by Yarlagadda et al. 56 , successful ablation of RVOT VT was performed in 23 patients ,...
In 1886, Frankel described bilateral adrenal tumors discovered at the autopsy of an 18-year-old woman who died suddenly following a year of retinitis and episodic palpitations, pounding heart, pallor, headaches, and vomiting. Her postmortem examination also revealed nephrosclerosis and myocardial hypertrophy.1
Unfortunately, about 40 of patients either fail to respond to diazoxide treatment or have clinical sequelae that compel them to discontinue its use. Seven of 41 patients at our medical center failed to respond to diazoxide.5 Fourteen of these 41 patients had complications (palpitations 13 , edema 5 , nausea 2 , gastrointestinal discomfort 2 , and elevated uric acid 2 ). Five of these patients had symptoms or complications that were so severe that they discontinued their diazoxide. Thus, diazoxide was successful in only 29 of our 41 patients.5 This response to the diazoxide treatment is comparable with that reported by other medical centers.18
The most frequent preoperative clinical features are episodes of headache, pallor, palpitations, and sweating. In the series of autopsies reported by Platts et al (1995), typical symptoms of phaeochromocytoma had been present for more than 3 months prior to death in 61 . Patients may have an unusually labile blood pressure and a pressor response to the induction of anaesthesia. One patient, who developed major cardiovascular complications during surgery for cerebral arteriovenous malformation, was found to have had a series of potentially life-threatening events over a 20-year period (Jones et al 1999).
From the catecholamine-secreting adrenal medullary cells. They are hormonally active and can present with classic signs and symptoms of excess catechol secretion hypertension, headache, heart palpitations, anxiety, and tremulousness. Complications of unrecognized disease include malignant hypertension, stroke, myocardial infarction, and cardiac arrhythmias. There are frequent reports of sudden death in patients with known or unsuspected pheochromocytomas who have undergone unrelated surgical procedures or during childbirth.
1986).These consisted of ST T-wave abnormalities (79 ), right axis deviation (40 ), a short PR interval (24 ), an abnormal R wave in V1 (20 ), abnormal inferolateral Q waves (14 ), and left ventricular hypertrophy (11 ). However, up to 50 of patients have clinical cardiac disease. Hypertrophic cardiomyopathy occurred in 20 , less frequently than previously thought, whilst 7 had nonhypertrophic cardiomyopathy, in which there was global hypofunction of the left ventricle. In a recent study of 55 patients, wide variations in cardiomyopathy were found and there was no relationship between it and the presence of ECG abnormalities (Dutka et al 1999). In affected patients, symptoms include palpitations and chest pain, and heart failure may supervene. Sudden death can occur.
Meta-analyses are often employed to evaluate either efficacy or safety. The difficulties and limitations of meta-analyses to evaluate safety are well demonstrated in Shekelle et al. (2003). They summarized adverse events (psychiatric symptoms, autonomic symptoms, upper-gastrointestinal symptoms, and heart palpitations) in 52 controlled trials, and concluded that subjects receiving ephedra or ephedrine for either weight loss or athletic performance, compared to controls, were at two to three times the risk of those adverse events. Given the size of the trials, they could not exclude that more serious adverse events may have occurred at rates less than one per thousand. They reported heterogeneity among the athletic performance trials, but did not observe heterogeneity among the weight loss trials. In another example of meta-analyses of a safety outcome, Freeman, Zehenbauer, and Buchman (2003) reported a meta-analysis of the risk of clinically significant bleeding with anticoagulant...
An undetermined number of patients self-administer herbal dietary supplements. Many of these supplements contain ephedra alkaloids, which may predispose the patient to perioperative hypertension and cardiac arrhythmias 90 . Some herbals may result in the increased incidence of bleeding from coumadin-like substances. Antiobesity medications such as aminorex fu-marate, dexfenfluramine (Redux), fenfluramine (pon-damin) and phentermine (Ionamin, Adipex-P, Fastin, Oby-Cap, Obenix, Oby-trim, Zantryl) are associated with pulmonary hypertension and valvular heart disease, even with as little as 2 months of use. While most patients develop symptoms such as palpitations, dys
Duodenum), midgut, and hindgut.34 Most MEN type I carcinoids are derived from the foregut (69 ).35 They occur in approximately 7 of patients with MEN type I. Foregut tumors produce the carcinoid syndrome less often than midgut tumors. Patients may have an atypical presentation with facial flush, lacrimation, headaches, and or bron-chospasm. Foregut tumors generally do not produce 5-hydroxytryptamine (5-HT), but many secrete histamine and 5-hydroxytrytophen (5-HTP), which is metabolized to 5-hydroxyindoleacetic acid (5-HIAA). Foregut carcinoids in MEN type I are generally bronchial (40 ), thymic (35 ), duodenal (20 ), or gastric (5 ).35 The mean age of diagnosis is approximately 40 years. Mediastinal carcinoid tumors have an increased propensity for malignancy ( 40 in MEN type I). Carcinoid tumors of the gastrointestinal tract are benign-appearing tumors of neuroendocrine origin and account for 1.5 of all gastrointestinal tract tumors.36 Overall, 30 to 40 occur in the appendix however,...
Of these patients, 5.8 had malignant insulinomas and 7.6 had MEN type I. Symptoms include blurred vision, confusion, abnormal behavior, sweating, weakness, hunger, anxiety, and palpitations. The diagnosis may not be made for years in symptomatic patients, many of whom are treated for seizures or psychiatric disturbances before the possibility of an insulinoma is entertained. The mean interval from onset of symptoms to diagnosis is approximately 3 years.4