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Palpitations

MedGen UID:
14579
Concept ID:
C0030252
Finding
Synonyms: Palpitation
SNOMED CT: Palpitations (80313002)
 
HPO: HP:0001962

Definition

A sensation that the heart is pounding or racing, which is a non-specific sign but may be a manifestation of arrhythmia. [from HPO]

Conditions with this feature

Primary erythromelalgia
MedGen UID:
8688
Concept ID:
C0014805
Disease or Syndrome
SCN9A-related inherited erythromelalgia (SCN9A-related IEM) is characterized by recurrent attacks of bilateral and symmetric intense pain, redness, warmth, and swelling involving the feet and, less frequently, the hands. SCN9A-related IEM is not associated with an organic disease. Manifestations may vary within a family. Onset is usually in childhood or adolescence but has been recognized in infants and adults. At onset, episodes are triggered by warmth; other precipitating factors include: exercise, tight shoes, wearing socks, alcohol, spicy foods, and other vasodilating agents. In advanced disease, symptoms may occur many times a day or become constant. Some individuals have allodynia (pain evoked by a normally innocuous stimulus) and hyperalgesia (increased sensitivity to a painful stimulus). Episodes may be disabling, interfere with sleep, and severely limit normal activities such as walking, participation in sports, wearing socks and shoes, and attending school or going to work.
Wolff-Parkinson-White pattern
MedGen UID:
12162
Concept ID:
C0043202
Disease or Syndrome
Wolff-Parkinson-White syndrome is a condition characterized by abnormal electrical pathways in the heart that cause a disruption of the heart's normal rhythm (arrhythmia).The heartbeat is controlled by electrical signals that move through the heart in a highly coordinated way. A specialized cluster of cells called the atrioventricular node conducts electrical impulses from the heart's upper chambers (the atria) to the lower chambers (the ventricles). Impulses move through the atrioventricular node during each heartbeat, stimulating the ventricles to contract slightly later than the atria.People with Wolff-Parkinson-White syndrome are born with an extra connection in the heart, called an accessory pathway, that allows electrical signals to bypass the atrioventricular node and move from the atria to the ventricles faster than usual. The accessory pathway may also transmit electrical impulses abnormally from the ventricles back to the atria. This extra connection can disrupt the coordinated movement of electrical signals through the heart, leading to an abnormally fast heartbeat (tachycardia) and other changes in heart rhythm. Resulting symptoms include dizziness, a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, and fainting (syncope). In rare cases, arrhythmias associated with Wolff-Parkinson-White syndrome can lead to cardiac arrest and sudden death. The most common arrhythmia associated with Wolff-Parkinson-White syndrome is called paroxysmal supraventricular tachycardia.Complications of Wolff-Parkinson-White syndrome can occur at any age, although some individuals born with an accessory pathway in the heart never experience any health problems associated with the condition.Wolff-Parkinson-White syndrome often occurs with other structural abnormalities of the heart or underlying heart disease. The most common heart defect associated with the condition is Ebstein anomaly, which affects the valve that allows blood to flow from the right atrium to the right ventricle (the tricuspid valve). Additionally, the heart rhythm problems associated with Wolff-Parkinson-White syndrome can be a component of several other genetic syndromes, including hypokalemic periodic paralysis (a condition that causes episodes of extreme muscle weakness), Pompe disease (a disorder characterized by the storage of excess glycogen), Danon disease (a condition that weakens the heart and skeletal muscles and causes intellectual disability), and tuberous sclerosis complex (a condition that results in the growth of noncancerous tumors in many parts of the body).
Thyrotoxic periodic paralysis
MedGen UID:
120639
Concept ID:
C0268446
Disease or Syndrome
Thyrotoxic periodic paralysis is a sporadic muscle disorder characterized by episodic attacks of weakness associated with hypokalemia in individuals with hyperthyroidism. The paralysis resolves upon treatment of hyperthyroidism. The disorder is most common among males of Asian descent, including Chinese, Japanese, Vietnamese, Filipino, and Koreans, although it occurs less commonly in individuals of Caucasian background. Thyrotoxic periodic paralysis is clinically similar to hereditary hypokalemic periodic paralysis (HOKPP; 170400), but the paralysis in TTPP occurs only in the presence of hyperthyroidism. TTPP can also be precipitated by factors that result in hypokalemia, such as carbohydrate ingestion and rest after exercise (review by Kung, 2006). Genetic Heterogeneity of Thyrotoxic Periodic Paralysis See also TTPP2 (613239), conferred by variation in the KCNJ18 gene (613236) on chromosome 17p11, and TTPP3 (614834), mapped to chromosome 17q24.
Myotonic dystrophy type 2
MedGen UID:
155755
Concept ID:
C0752354
Myotonic dystrophy type 2 (DM2) is characterized by myotonia (90% of affected individuals) and muscle dysfunction (weakness, pain, and stiffness) (82%), and less commonly by cardiac conduction defects, iridescent posterior subcapsular cataracts, insulin-insensitive type 2 diabetes mellitus, and testicular failure. Although myotonia (involuntary muscle contraction with delayed relaxation) has been reported during the first decade, onset is typically in the third decade, most commonly with fluctuating or episodic muscle pain that can be debilitating and weakness of the neck flexors and finger flexors. Subsequently, weakness occurs in the elbow extensors and the hip flexors and extensors. Facial weakness and weakness of the ankle dorsiflexors are less common. Myotonia rarely causes severe symptoms.
Andersen Tawil syndrome
MedGen UID:
327586
Concept ID:
C1563715
Disease or Syndrome
Andersen-Tawil syndrome (ATS) is characterized by a triad of episodic flaccid muscle weakness (i.e., periodic paralysis), ventricular arrhythmias and prolonged QT interval, and anomalies including low-set ears, widely spaced eyes, small mandible, fifth-digit clinodactyly, syndactyly, short stature, and scoliosis. Affected individuals present in the first or second decade with either cardiac symptoms (palpitations and/or syncope) or weakness that occurs spontaneously following prolonged rest or following rest after exertion. Mild permanent weakness is common. Mild learning difficulties and a distinct neurocognitive phenotype (i.e., deficits in executive function and abstract reasoning) have been described.
Dilated cardiomyopathy 1E
MedGen UID:
331341
Concept ID:
C1832680
Disease or Syndrome
Nonsyndromic isolated dilated cardiomyopathy (DCM) is characterized by left ventricular enlargement and systolic dysfunction, a reduction in the myocardial force of contraction. DCM usually presents with any one of the following: Heart failure with symptoms of congestion (edema, orthopnea, paroxysmal nocturnal dyspnea) and/or reduced cardiac output (fatigue, dyspnea on exertion). Arrhythmias and/or conduction system disease. Thromboembolic disease (from left ventricular mural thrombus) including stroke.
Arrhythmogenic right ventricular cardiomyopathy, type 9
MedGen UID:
373205
Concept ID:
C1836906
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
Myopathy with lactic acidosis, hereditary
MedGen UID:
342573
Concept ID:
C1850718
Disease or Syndrome
Myopathy with deficiency of ISCU, a mitochondrial myopathy, is classically characterized by lifelong exercise intolerance in which minor exertion causes tachycardia, shortness of breath, fatigue, and pain of active muscles; episodes of more profound exercise intolerance associated with rhabdomyolysis, myoglobinuria, and weakness that may be severe; and typically full recovery of muscle strength between episodes of rhabdomyolysis. Affected individuals usually have near-normal strength; they can have large calves.
Paragangliomas 3
MedGen UID:
340200
Concept ID:
C1854336
Disease or Syndrome
Hereditary paraganglioma-pheochromocytoma (PGL/PCC) syndromes are characterized by paragangliomas (tumors that arise from neuroendocrine tissues symmetrically distributed along the paravertebral axis from the base of the skull to the pelvis) and by pheochromocytomas (paragangliomas that are confined to the adrenal medulla). Sympathetic paragangliomas hypersecrete catecholamines; parasympathetic paragangliomas are most often nonsecretory. Extra-adrenal parasympathetic paragangliomas are located predominantly in the skull base, neck, and upper medistinum; approximately 95% of such tumors are nonsecretory. In contrast, sympathetic extra-adrenal paragangliomas are generally confined to the lower mediastinum, abdomen, and pelvis, and are typically secretory. Pheochromocytomas, which arise from the adrenal medulla, typically hypersecrete catecholamines. Symptoms of PGL/PCC result either from mass effects or catecholamine hypersecretion (e.g., sustained or paroxysmal elevations in blood pressure, headache, episodic profuse sweating, forceful palpitations, pallor, and apprehension or anxiety). The risk for malignant transformation is greater for extra-adrenal sympathetic paragangliomas than for pheochromocytomas or skull base and neck paragangliomas.
Arrhythmogenic right ventricular cardiomyopathy, type 10
MedGen UID:
347543
Concept ID:
C1857777
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
Arrhythmogenic right ventricular cardiomyopathy, type 5
MedGen UID:
346805
Concept ID:
C1858379
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
Paragangliomas 4
MedGen UID:
349380
Concept ID:
C1861848
Neoplastic Process
Hereditary paraganglioma-pheochromocytoma (PGL/PCC) syndromes are characterized by paragangliomas (tumors that arise from neuroendocrine tissues symmetrically distributed along the paravertebral axis from the base of the skull to the pelvis) and by pheochromocytomas (paragangliomas that are confined to the adrenal medulla). Sympathetic paragangliomas hypersecrete catecholamines; parasympathetic paragangliomas are most often nonsecretory. Extra-adrenal parasympathetic paragangliomas are located predominantly in the skull base, neck, and upper medistinum; approximately 95% of such tumors are nonsecretory. In contrast, sympathetic extra-adrenal paragangliomas are generally confined to the lower mediastinum, abdomen, and pelvis, and are typically secretory. Pheochromocytomas, which arise from the adrenal medulla, typically hypersecrete catecholamines. Symptoms of PGL/PCC result either from mass effects or catecholamine hypersecretion (e.g., sustained or paroxysmal elevations in blood pressure, headache, episodic profuse sweating, forceful palpitations, pallor, and apprehension or anxiety). The risk for malignant transformation is greater for extra-adrenal sympathetic paragangliomas than for pheochromocytomas or skull base and neck paragangliomas.
Arrhythmogenic right ventricular cardiomyopathy, type 11
MedGen UID:
351237
Concept ID:
C1864850
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
Short QT syndrome 3
MedGen UID:
400662
Concept ID:
C1865018
Disease or Syndrome
Short QT syndrome is a cardiac channelopathy associated with a predisposition to atrial fibrillation and sudden cardiac death. Patients have a structurally normal heart, but electrocardiography (ECG) exhibits abbreviated QTc (Bazett's corrected QT) intervals of less than 360 ms (summary by Moreno et al., 2015). For a discussion of genetic heterogeneity of short QT syndrome, see SQT1 (609620).
Short QT syndrome 1
MedGen UID:
355891
Concept ID:
C1865020
Disease or Syndrome
Short QT syndrome is a cardiac channelopathy associated with a predisposition to atrial fibrillation and sudden cardiac death. Patients have a structurally normal heart, but electrocardiography (ECG) exhibits abbreviated QTc (Bazett's corrected QT) intervals of less than 360 ms (summary by Moreno et al., 2015). Genetic Heterogeneity of Short QT Syndrome Short QT syndrome-2 (SQT2; 609621) is caused by mutation in the KCNQ1 gene (607542). SQT3 (609622) is caused by mutation in the KCNJ2 gene (600681).
Paragangliomas 1
MedGen UID:
358258
Concept ID:
C1868633
Disease or Syndrome
Hereditary paraganglioma-pheochromocytoma (PGL/PCC) syndromes are characterized by paragangliomas (tumors that arise from neuroendocrine tissues symmetrically distributed along the paravertebral axis from the base of the skull to the pelvis) and by pheochromocytomas (paragangliomas that are confined to the adrenal medulla). Sympathetic paragangliomas hypersecrete catecholamines; parasympathetic paragangliomas are most often nonsecretory. Extra-adrenal parasympathetic paragangliomas are located predominantly in the skull base, neck, and upper medistinum; approximately 95% of such tumors are nonsecretory. In contrast, sympathetic extra-adrenal paragangliomas are generally confined to the lower mediastinum, abdomen, and pelvis, and are typically secretory. Pheochromocytomas, which arise from the adrenal medulla, typically hypersecrete catecholamines. Symptoms of PGL/PCC result either from mass effects or catecholamine hypersecretion (e.g., sustained or paroxysmal elevations in blood pressure, headache, episodic profuse sweating, forceful palpitations, pallor, and apprehension or anxiety). The risk for malignant transformation is greater for extra-adrenal sympathetic paragangliomas than for pheochromocytomas or skull base and neck paragangliomas.
Atrial fibrillation, familial, 7
MedGen UID:
393658
Concept ID:
C2677106
Disease or Syndrome
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance, affecting more than 2 million Americans, with an overall prevalence of 0.89%. The prevalence increases rapidly with age, to 2.3% between the ages of 40 and 60 years, and to 5.9% over the age of 65. The most dreaded complication is thromboembolic stroke (Brugada et al., 1997). For a discussion of genetic heterogeneity of atrial fibrillation, see 608583.
Thyrotoxic periodic paralysis 2
MedGen UID:
413851
Concept ID:
C2750473
Finding
Familial hypertrophic cardiomyopathy 17
MedGen UID:
462614
Concept ID:
C3151264
Disease or Syndrome
Brugada syndrome 9
MedGen UID:
903155
Concept ID:
C4225340
Disease or Syndrome
Brugada syndrome is characterized by cardiac conduction abnormalities (ST-segment abnormalities in leads V1-V3 on ECG and a high risk for ventricular arrhythmias) that can result in sudden death. Brugada syndrome presents primarily during adulthood although age at diagnosis may range from infancy to late adulthood. The mean age of sudden death is approximately 40 years. Clinical presentations may also include sudden infant death syndrome (SIDS; death of a child during the first year of life without an identifiable cause) and the sudden unexpected nocturnal death syndrome (SUNDS), a typical presentation in individuals from Southeast Asia. Other conduction defects can include first-degree AV block, intraventricular conduction delay, right bundle branch block, and sick sinus syndrome.

Recent clinical studies

Etiology

Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M
Europace 2016 Aug;18(8):1265-72. Epub 2015 Oct 29 doi: 10.1093/europace/euv311. PMID: 26519025Free PMC Article
Evans T, Holdsworth DA, Jackson S, Nicol E
J R Army Med Corps 2015 Sep;161(3):192-9. Epub 2015 Aug 4 doi: 10.1136/jramc-2015-000507. PMID: 26243805
Probst MA, Kanzaria HK, Hoffman JR, Mower WR, Moheimani RS, Sun BC, Quigley DD
J Emerg Med 2015 Aug;49(2):236-43.e2. Epub 2015 May 2 doi: 10.1016/j.jemermed.2015.02.013. PMID: 25943288Free PMC Article
Balachandran AA, Duckett JR
Eur J Obstet Gynecol Reprod Biol 2015 Apr;187:60-3. Epub 2015 Feb 19 doi: 10.1016/j.ejogrb.2015.02.020. PMID: 25756594
Salam AM, Gersh BJ, AlBinali HA, Singh R, Asaad N, Al-Qahtani A, Suwaidi JA
Int J Clin Pract 2014 Jan;68(1):122-9. doi: 10.1111/ijcp.12230. PMID: 24341306

Diagnosis

Harskamp RE, Thole OB, Moggré I
Practitioner 2017 Apr;261(1803):23-5. PMID: 29020730
Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M
Europace 2016 Aug;18(8):1265-72. Epub 2015 Oct 29 doi: 10.1093/europace/euv311. PMID: 26519025Free PMC Article
Evans T, Holdsworth DA, Jackson S, Nicol E
J R Army Med Corps 2015 Sep;161(3):192-9. Epub 2015 Aug 4 doi: 10.1136/jramc-2015-000507. PMID: 26243805
Probst MA, Kanzaria HK, Hoffman JR, Mower WR, Moheimani RS, Sun BC, Quigley DD
J Emerg Med 2015 Aug;49(2):236-43.e2. Epub 2015 May 2 doi: 10.1016/j.jemermed.2015.02.013. PMID: 25943288Free PMC Article
de Asmundis C, Conte G, Sieira J, Chierchia GB, Rodriguez-Manero M, Di Giovanni G, Ciconte G, Levinstein M, Baltogiannis G, Saitoh Y, Casado-Arroyo R, Brugada P
Europace 2014 Aug;16(8):1231-5. Epub 2014 Feb 26 doi: 10.1093/europace/eut411. PMID: 24574492

Therapy

Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M
Europace 2016 Aug;18(8):1265-72. Epub 2015 Oct 29 doi: 10.1093/europace/euv311. PMID: 26519025Free PMC Article
Balachandran AA, Duckett JR
Eur J Obstet Gynecol Reprod Biol 2015 Apr;187:60-3. Epub 2015 Feb 19 doi: 10.1016/j.ejogrb.2015.02.020. PMID: 25756594
Ocak T, Erdem A, Duran A, Tekelioğlu ÜY, Öztürk S, Ayhan SS, Özlü MF, Tosun M, Koçoğlu H, Yazıcı M
Clinics (Sao Paulo) 2013 Apr;68(4):543-7. doi: 10.6061/clinics/2013(04)17. PMID: 23778331Free PMC Article
Jonsbu E, Martinsen EW, Morken G, Moum T, Dammen T
Behav Cogn Psychother 2013 Jul;41(4):398-407. Epub 2013 Mar 18 doi: 10.1017/S1352465813000179. PMID: 23507293
Vallès E, Martí-Almor J, Bazan V, Suarez F, Cian D, Portillo L, Bruguera-Cortada J
Am J Cardiol 2011 May 1;107(9):1333-7. Epub 2011 Mar 2 doi: 10.1016/j.amjcard.2010.12.047. PMID: 21371684

Prognosis

Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M
Europace 2016 Aug;18(8):1265-72. Epub 2015 Oct 29 doi: 10.1093/europace/euv311. PMID: 26519025Free PMC Article
de Asmundis C, Conte G, Sieira J, Chierchia GB, Rodriguez-Manero M, Di Giovanni G, Ciconte G, Levinstein M, Baltogiannis G, Saitoh Y, Casado-Arroyo R, Brugada P
Europace 2014 Aug;16(8):1231-5. Epub 2014 Feb 26 doi: 10.1093/europace/eut411. PMID: 24574492
Salam AM, Gersh BJ, AlBinali HA, Singh R, Asaad N, Al-Qahtani A, Suwaidi JA
Int J Clin Pract 2014 Jan;68(1):122-9. doi: 10.1111/ijcp.12230. PMID: 24341306
Nyrnes A, Mathiesen EB, Njølstad I, Wilsgaard T, Løchen ML
Eur J Prev Cardiol 2013 Oct;20(5):729-36. Epub 2012 May 15 doi: 10.1177/2047487312446562. PMID: 22588086
Vallès E, Martí-Almor J, Bazan V, Suarez F, Cian D, Portillo L, Bruguera-Cortada J
Am J Cardiol 2011 May 1;107(9):1333-7. Epub 2011 Mar 2 doi: 10.1016/j.amjcard.2010.12.047. PMID: 21371684

Clinical prediction guides

Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M
Europace 2016 Aug;18(8):1265-72. Epub 2015 Oct 29 doi: 10.1093/europace/euv311. PMID: 26519025Free PMC Article
de Asmundis C, Conte G, Sieira J, Chierchia GB, Rodriguez-Manero M, Di Giovanni G, Ciconte G, Levinstein M, Baltogiannis G, Saitoh Y, Casado-Arroyo R, Brugada P
Europace 2014 Aug;16(8):1231-5. Epub 2014 Feb 26 doi: 10.1093/europace/eut411. PMID: 24574492
Salam AM, Gersh BJ, AlBinali HA, Singh R, Asaad N, Al-Qahtani A, Suwaidi JA
Int J Clin Pract 2014 Jan;68(1):122-9. doi: 10.1111/ijcp.12230. PMID: 24341306
Nyrnes A, Mathiesen EB, Njølstad I, Wilsgaard T, Løchen ML
Eur J Prev Cardiol 2013 Oct;20(5):729-36. Epub 2012 May 15 doi: 10.1177/2047487312446562. PMID: 22588086
Vallès E, Martí-Almor J, Bazan V, Suarez F, Cian D, Portillo L, Bruguera-Cortada J
Am J Cardiol 2011 May 1;107(9):1333-7. Epub 2011 Mar 2 doi: 10.1016/j.amjcard.2010.12.047. PMID: 21371684

Recent systematic reviews

Harskamp RE, Thole OB, Moggré I
Practitioner 2017 Apr;261(1803):23-5. PMID: 29020730
Wilken J
Med Clin North Am 2016 Sep;100(5):981-9. doi: 10.1016/j.mcna.2016.04.006. PMID: 27542418
Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L, Morgan JM, Raatikainen MJ, Steinbeck G, Viskin S, Kirchhof P, Braunschweig F, Borggrefe M, Hocini M, Della Bella P, Shah DC; European Heart Rhythm Association.
Europace 2011 Jul;13(7):920-34. doi: 10.1093/europace/eur130. PMID: 21697315
Thavendiranathan P, Bagai A, Khoo C, Dorian P, Choudhry NK
JAMA 2009 Nov 18;302(19):2135-43. doi: 10.1001/jama.2009.1673. PMID: 19920238
Lawless CE, Briner W
Sports Med 2008;38(8):687-702. PMID: 18620468

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