<s>
Palpitations	B-Algorithm
are	O
perceived	O
abnormalities	O
of	O
the	O
heartbeat	O
characterized	O
by	O
awareness	O
of	O
cardiac	O
muscle	O
contractions	O
in	O
the	O
chest	O
,	O
which	O
is	O
further	O
characterized	O
by	O
the	O
hard	O
,	O
fast	O
and/or	O
irregular	O
beatings	O
of	O
the	O
heart	O
.	O
</s>
<s>
Palpitations	B-Algorithm
are	O
a	O
sensory	O
symptom	O
and	O
are	O
often	O
described	O
as	O
a	O
skipped	B-Algorithm
beat	I-Algorithm
,	O
rapid	O
fluttering	O
in	O
the	O
chest	O
,	O
pounding	O
sensation	O
in	O
the	O
chest	O
or	O
neck	O
,	O
or	O
a	O
flip-flopping	O
in	O
the	O
chest	O
.	O
</s>
<s>
Palpitation	B-Algorithm
can	O
be	O
associated	O
with	O
anxiety	O
and	O
does	O
not	O
necessarily	O
indicate	O
a	O
structural	O
or	O
functional	O
abnormality	O
of	O
the	O
heart	O
,	O
but	O
it	O
can	O
be	O
a	O
symptom	O
arising	O
from	O
an	O
objectively	O
rapid	O
or	O
irregular	B-Application
heartbeat	I-Application
.	O
</s>
<s>
Palpitation	B-Algorithm
can	O
be	O
intermittent	O
and	O
of	O
variable	O
frequency	O
and	O
duration	O
,	O
or	O
continuous	O
.	O
</s>
<s>
Palpitation	B-Algorithm
may	O
be	O
associated	O
with	O
coronary	O
heart	O
disease	O
,	O
hyperthyroidism	O
,	O
diseases	O
affecting	O
cardiac	O
muscle	O
such	O
as	O
hypertrophic	O
cardiomyopathy	O
,	O
diseases	O
causing	O
low	O
blood	O
oxygen	O
such	O
as	O
asthma	O
and	O
emphysema	O
;	O
previous	O
chest	O
surgery	O
;	O
kidney	O
disease	O
;	O
blood	O
loss	O
and	O
pain	O
;	O
anemia	O
;	O
drugs	O
such	O
as	O
antidepressants	O
,	O
statins	O
,	O
alcohol	O
,	O
nicotine	B-Operating_System
,	O
caffeine	B-Application
,	O
cocaine	B-Application
and	O
amphetamines	O
;	O
electrolyte	O
imbalances	O
of	O
magnesium	O
,	O
potassium	O
and	O
calcium	O
;	O
and	O
deficiencies	O
of	O
nutrients	O
such	O
as	O
taurine	O
,	O
arginine	O
,	O
iron	O
,	O
vitamin	O
B12	O
.	O
</s>
<s>
Three	O
common	O
descriptions	O
of	O
palpitation	B-Algorithm
are	O
"	O
flip-flopping	O
"	O
(	O
or	O
"	O
stop	O
and	O
start	O
"	O
)	O
,	O
often	O
caused	O
by	O
premature	B-Application
contraction	I-Application
of	O
the	O
atrium	O
or	O
ventricle	O
,	O
with	O
the	O
perceived	O
"	O
stop	O
"	O
from	O
the	O
pause	O
following	O
the	O
contraction	O
,	O
and	O
the	O
"	O
start	O
"	O
from	O
the	O
subsequent	O
forceful	O
contraction	O
;	O
rapid	O
"	O
fluttering	O
in	O
the	O
chest	O
"	O
,	O
with	O
regular	O
"	O
fluttering	O
"	O
suggesting	O
supraventricular	B-Algorithm
or	O
ventricular	O
arrhythmias	B-Application
(	O
including	O
sinus	B-Algorithm
tachycardia	I-Algorithm
)	O
and	O
irregular	O
"	O
fluttering	O
"	O
suggesting	O
atrial	B-Application
fibrillation	I-Application
,	O
atrial	O
flutter	O
,	O
or	O
tachycardia	B-Application
with	O
variable	O
block	O
;	O
and	O
"	O
pounding	O
in	O
the	O
neck	O
"	O
or	O
neck	O
pulsations	O
,	O
often	O
due	O
to	O
cannon	O
A	O
waves	O
in	O
the	O
jugular	O
venous	O
,	O
pulsations	O
that	O
occur	O
when	O
the	O
right	O
atrium	O
contracts	O
against	O
a	O
closed	O
tricuspid	O
valve	O
.	O
</s>
<s>
Palpitation	B-Algorithm
associated	O
with	O
chest	O
pain	O
suggests	O
coronary	O
artery	O
disease	O
,	O
or	O
if	O
the	O
chest	O
pain	O
is	O
relieved	O
by	O
leaning	O
forward	O
,	O
pericardial	O
disease	O
is	O
suspected	O
.	O
</s>
<s>
Palpitation	B-Algorithm
associated	O
with	O
light-headedness	O
,	O
fainting	O
or	O
near	O
fainting	O
suggest	O
low	O
blood	O
pressure	O
and	O
may	O
signify	O
a	O
life-threatening	O
abnormal	B-Application
heart	I-Application
rhythm	I-Application
.	O
</s>
<s>
Palpitation	B-Algorithm
that	O
occurs	O
regularly	O
with	O
exertion	O
suggests	O
a	O
rate-dependent	O
bypass	O
tract	O
or	O
hypertrophic	O
cardiomyopathy	O
.	O
</s>
<s>
Noncardiac	O
symptoms	O
should	O
also	O
be	O
elicited	O
since	O
the	O
palpitations	B-Algorithm
may	O
be	O
caused	O
by	O
a	O
normal	O
heart	O
responding	O
to	O
a	O
metabolic	O
or	O
inflammatory	O
condition	O
.	O
</s>
<s>
Palpitation	B-Algorithm
can	O
be	O
precipitated	O
by	O
vomiting	O
or	O
diarrhea	O
that	O
leads	O
to	O
electrolyte	O
disorders	O
and	O
hypovolemia	O
.	O
</s>
<s>
Hyperventilation	O
,	O
hand	O
tingling	O
,	O
and	O
nervousness	O
are	O
common	O
when	O
anxiety	O
or	O
panic	O
disorder	O
is	O
the	O
cause	O
of	O
the	O
palpitations	B-Algorithm
.	O
</s>
<s>
Palpitations	B-Algorithm
are	O
a	O
widely	O
diffused	O
complaint	O
and	O
particularly	O
in	O
subjects	O
affected	O
by	O
structural	O
heart	O
disease	O
.	O
</s>
<s>
The	O
list	O
of	O
etiologies	O
of	O
palpitations	B-Algorithm
is	O
long	O
,	O
and	O
in	O
some	O
cases	O
,	O
the	O
etiology	O
is	O
unable	O
to	O
be	O
determined	O
.	O
</s>
<s>
In	O
one	O
study	O
reporting	O
the	O
etiology	O
of	O
palpitations	B-Algorithm
,	O
43%	O
were	O
found	O
to	O
be	O
of	O
cardiac	O
etiology	O
,	O
31%	O
of	O
psychiatric	O
etiology	O
and	O
approximately	O
10%	O
were	O
classified	O
as	O
miscellaneous	O
(	O
medication	O
induced	O
,	O
thyrotoxicosis	O
,	O
caffeine	B-Application
,	O
cocaine	B-Application
,	O
anemia	O
,	O
amphetamine	O
,	O
mastocytosis	O
)	O
.	O
</s>
<s>
The	O
cardiac	O
etiologies	O
of	O
palpitations	B-Algorithm
are	O
the	O
most	O
life-threatening	O
and	O
include	O
ventricular	O
sources	O
(	O
premature	B-Error_Name
ventricular	I-Error_Name
contractions	I-Error_Name
(	O
PVC	B-Error_Name
)	O
,	O
ventricular	B-Application
tachycardia	I-Application
and	O
ventricular	O
fibrillation	O
)	O
,	O
atrial	O
sources	O
(	O
atrial	B-Application
fibrillation	I-Application
,	O
atrial	O
flutter	O
)	O
high	O
output	O
states	O
(	O
anemia	O
,	O
AV	O
fistula	O
,	O
Paget	O
's	O
disease	O
of	O
bone	O
or	O
pregnancy	O
)	O
,	O
structural	O
abnormalities	O
(	O
congenital	O
heart	O
disease	O
,	O
cardiomegaly	O
,	O
aortic	O
aneurysm	O
,	O
or	O
acute	O
left	O
ventricular	O
failure	O
)	O
,	O
and	O
miscellaneous	O
sources	O
(	O
postural	O
orthostatic	O
tachycardia	B-Application
syndrome	O
abbreviated	O
as	O
POTS	O
,	O
Brugada	O
syndrome	O
,	O
and	O
sinus	B-Algorithm
tachycardia	I-Algorithm
)	O
.	O
</s>
<s>
Palpitation	B-Algorithm
can	O
be	O
attributed	O
to	O
one	O
of	O
four	O
main	O
causes	O
:	O
</s>
<s>
Abnormal	B-Application
heart	I-Application
rhythms	I-Application
(	O
ectopic	B-Algorithm
beat	I-Algorithm
,	O
premature	B-Algorithm
atrial	I-Algorithm
contraction	I-Algorithm
,	O
junctional	B-Algorithm
escape	I-Algorithm
beat	I-Algorithm
,	O
premature	B-Error_Name
ventricular	I-Error_Name
contraction	I-Error_Name
,	O
atrial	B-Application
fibrillation	I-Application
,	O
supraventricular	B-Algorithm
tachycardia	I-Algorithm
,	O
ventricular	B-Application
tachycardia	I-Application
,	O
ventricular	O
fibrillation	O
,	O
heart	B-Algorithm
block	I-Algorithm
)	O
.	O
</s>
<s>
Palpitations	B-Algorithm
can	O
occur	O
during	O
times	O
of	O
catecholamine	O
excess	O
,	O
such	O
as	O
during	O
exercise	O
or	O
at	O
times	O
of	O
stress	O
.	O
</s>
<s>
The	O
cause	O
of	O
the	O
palpitations	B-Algorithm
during	O
these	O
conditions	O
is	O
often	O
a	O
sustained	O
supraventricular	B-Algorithm
tachycardia	I-Algorithm
or	O
ventricular	B-Application
tachyarrhythmia	I-Application
.	O
</s>
<s>
Supraventricular	B-Algorithm
tachycardias	I-Algorithm
can	O
also	O
be	O
induced	O
at	O
the	O
termination	O
of	O
exercise	O
when	O
the	O
withdrawal	O
of	O
catecholamines	O
is	O
coupled	O
with	O
a	O
surge	O
in	O
the	O
vagal	O
tone	O
.	O
</s>
<s>
Palpitations	B-Algorithm
secondary	O
to	O
catecholamine	O
excess	O
may	O
also	O
occur	O
during	O
emotionally	O
startling	O
experiences	O
,	O
especially	O
in	O
patients	O
with	O
a	O
long	O
QT	O
syndrome	O
.	O
</s>
<s>
Vagus	O
nerve	O
induced	O
palpitation	B-Algorithm
is	O
felt	O
as	O
a	O
thud	O
,	O
a	O
hollow	O
fluttery	O
sensation	O
,	O
or	O
a	O
skipped	B-Algorithm
beat	I-Algorithm
,	O
depending	O
on	O
at	O
what	O
point	O
during	O
the	O
heart	O
's	O
normal	O
rhythm	O
the	O
vagus	O
nerve	O
fires	O
.	O
</s>
<s>
In	O
many	O
cases	O
,	O
the	O
anxiety	O
and	O
panic	O
of	O
experiencing	O
palpitations	B-Algorithm
cause	O
a	O
patient	O
to	O
experience	O
further	O
anxiety	O
and	O
increased	O
vagus	O
nerve	O
stimulation	O
.	O
</s>
<s>
The	O
link	O
between	O
anxiety	O
and	O
palpitation	B-Algorithm
may	O
also	O
explain	O
why	O
many	O
panic	O
attacks	O
involve	O
an	O
impending	O
sense	O
of	O
cardiac	O
arrest	O
.	O
</s>
<s>
Similarly	O
,	O
physical	O
and	O
mental	O
stress	O
may	O
contribute	O
to	O
the	O
occurrence	O
of	O
palpitation	B-Algorithm
,	O
possibly	O
due	O
to	O
the	O
depletion	O
of	O
certain	O
micronutrients	O
involved	O
in	O
maintaining	O
healthy	O
psychological	O
and	O
physiological	O
function	O
.	O
</s>
<s>
Gastrointestinal	O
bloating	O
,	O
indigestion	O
and	O
hiccups	O
have	O
also	O
been	O
associated	O
with	O
overstimulation	O
of	O
the	O
vagus	O
nerve	O
causing	O
palpitations	B-Algorithm
,	O
due	O
to	O
branches	O
of	O
the	O
vagus	O
nerve	O
innervating	O
the	O
GI	O
tract	O
,	O
diaphragm	O
,	O
and	O
lungs	O
.	O
</s>
<s>
Many	O
psychiatric	O
conditions	O
can	O
result	O
in	O
palpitations	B-Algorithm
including	O
depression	O
,	O
generalized	O
anxiety	O
disorder	O
,	O
panic	O
attacks	O
,	O
and	O
somatization	O
.	O
</s>
<s>
However	O
one	O
study	O
noted	O
that	O
up	O
to	O
67%	O
of	O
patients	O
diagnosed	O
with	O
a	O
mental	O
health	O
condition	O
had	O
an	O
underlying	O
arrhythmia	B-Application
.	O
</s>
<s>
There	O
are	O
many	O
metabolic	O
conditions	O
that	O
can	O
result	O
in	O
palpitations	B-Algorithm
including	O
,	O
hyperthyroidism	O
,	O
hypoglycemia	O
,	O
hypocalcemia	O
,	O
hyperkalemia	O
,	O
hypokalemia	O
,	O
hypermagnesemia	O
,	O
hypomagnesemia	O
,	O
and	O
pheochromocytoma	O
.	O
</s>
<s>
The	O
medications	O
most	O
likely	O
to	O
result	O
in	O
palpitations	B-Algorithm
include	O
sympathomimetic	O
agents	O
,	O
anticholinergic	O
drugs	O
,	O
vasodilators	O
and	O
withdrawal	O
from	O
beta	O
blockers	O
.	O
</s>
<s>
Common	O
etiologies	O
also	O
include	O
excess	O
caffeine	B-Application
,	O
or	O
marijuana	O
.	O
</s>
<s>
Cocaine	B-Application
,	O
amphetamines	O
,	O
3-4	O
methylenedioxymethamphetamine	O
(	O
Ecstasy	O
or	O
MDMA	O
)	O
can	O
also	O
cause	O
palpitations	B-Algorithm
.	O
</s>
<s>
The	O
sensation	O
of	O
palpitations	B-Algorithm
can	O
arise	O
from	O
extra-systoles	O
or	O
tachyarrhythmia	B-Application
.	O
</s>
<s>
It	O
is	O
very	O
rarely	O
noted	O
due	O
to	O
bradycardia	B-Algorithm
.	O
</s>
<s>
Palpitations	B-Algorithm
can	O
be	O
described	O
in	O
many	O
ways	O
.	O
</s>
<s>
The	O
description	O
of	O
the	O
symptoms	O
may	O
provide	O
a	O
clue	O
regarding	O
the	O
etiology	O
of	O
the	O
palpitations	B-Algorithm
,	O
and	O
the	O
pathophysiology	O
of	O
each	O
of	O
these	O
descriptions	O
is	O
thought	O
to	O
be	O
different	O
.	O
</s>
<s>
In	O
patients	O
who	O
describe	O
the	O
palpitations	B-Algorithm
as	O
a	O
brief	O
flip-flopping	O
in	O
the	O
chest	O
,	O
the	O
palpitations	B-Algorithm
are	O
thought	O
to	O
be	O
caused	O
by	O
extra	O
-	O
systoles	O
such	O
as	O
supraventricular	B-Algorithm
or	O
ventricular	B-Error_Name
premature	I-Error_Name
contractions	I-Error_Name
.	O
</s>
<s>
The	O
sensation	O
of	O
rapid	O
fluttering	O
in	O
the	O
chest	O
is	O
thought	O
to	O
result	O
from	O
a	O
sustained	O
ventricular	O
or	O
supraventricular	B-Algorithm
arrhythmia	I-Algorithm
.	O
</s>
<s>
Furthermore	O
,	O
the	O
sudden	O
cessation	O
of	O
this	O
arrythmia	B-Application
can	O
suggest	O
paroxysmal	B-Algorithm
supraventricular	I-Algorithm
tachycardia	I-Algorithm
.	O
</s>
<s>
This	O
is	O
further	O
supported	O
if	O
the	O
patient	O
can	O
stop	O
the	O
palpitations	B-Algorithm
by	O
using	O
Valsalva	O
maneuvers	O
.	O
</s>
<s>
The	O
rhythm	O
of	O
the	O
palpitations	B-Algorithm
may	O
indicate	O
the	O
etiology	O
of	O
the	O
palpitations	B-Algorithm
(	O
irregular	O
palpitations	B-Algorithm
indicate	O
atrial	B-Application
fibrillation	I-Application
as	O
a	O
source	O
of	O
the	O
palpitations	B-Algorithm
)	O
.	O
</s>
<s>
Palpitations	B-Algorithm
induced	O
by	O
exercise	O
could	O
be	O
suggestive	O
of	O
cardiomyopathy	O
,	O
ischemia	O
or	O
channelopathies	O
.	O
</s>
<s>
The	O
most	O
important	O
initial	O
clue	O
to	O
the	O
diagnosis	O
is	O
one	O
's	O
description	O
of	O
palpitation	B-Algorithm
.	O
</s>
<s>
The	O
approximate	O
age	O
of	O
the	O
person	O
when	O
first	O
noticed	O
and	O
the	O
circumstances	O
under	O
which	O
they	O
occur	O
are	O
important	O
,	O
as	O
is	O
information	O
about	O
caffeine	B-Application
intake	O
(	O
tea	O
or	O
coffee	O
drinking	O
)	O
,	O
and	O
whether	O
continual	O
palpitations	B-Algorithm
can	O
be	O
stopped	O
by	O
deep	O
breathing	O
or	O
changing	O
body	O
positions	O
.	O
</s>
<s>
If	O
the	O
person	O
has	O
discovered	O
a	O
way	O
of	O
stopping	O
the	O
palpitations	B-Algorithm
,	O
that	O
is	O
also	O
helpful	O
information	O
.	O
</s>
<s>
A	O
complete	O
and	O
detailed	O
history	O
and	O
physical	O
examination	O
are	O
two	O
essential	O
elements	O
of	O
the	O
evaluation	O
of	O
a	O
patient	O
with	O
palpitations	B-Algorithm
.	O
</s>
<s>
Social	O
history	O
,	O
including	O
exercise	O
habits	O
,	O
caffeine	B-Application
consumption	O
,	O
alcohol	O
and	O
illicit	O
drug	O
use	O
,	O
should	O
also	O
be	O
determined	O
.	O
</s>
<s>
Also	O
,	O
past	O
medical	O
history	O
and	O
family	O
history	O
may	O
provide	O
indications	O
to	O
the	O
etiology	O
of	O
the	O
palpitations	B-Algorithm
.	O
</s>
<s>
Palpitations	B-Algorithm
that	O
have	O
been	O
a	O
condition	O
since	O
childhood	O
are	O
most	O
likely	O
caused	O
by	O
a	O
supraventricular	B-Algorithm
tachycardia	I-Algorithm
,	O
whereas	O
palpitations	B-Algorithm
that	O
first	O
occur	O
later	O
in	O
life	O
are	O
more	O
likely	O
to	O
be	O
secondary	O
to	O
structural	O
heart	O
disease	O
.	O
</s>
<s>
A	O
rapid	O
regular	O
rhythm	O
is	O
more	O
likely	O
to	O
be	O
secondary	O
to	O
paroxysmal	B-Algorithm
supraventricular	I-Algorithm
tachycardia	I-Algorithm
or	O
ventricular	B-Application
tachycardia	I-Application
,	O
and	O
a	O
rapid	O
and	O
irregular	O
rhythm	O
is	O
more	O
likely	O
to	O
be	O
an	O
indication	O
of	O
atrial	B-Application
fibrillation	I-Application
,	O
atrial	O
flutter	O
,	O
or	O
tachycardia	B-Application
with	O
variable	O
block	O
.	O
</s>
<s>
Supraventricular	B-Algorithm
and	O
ventricular	B-Application
tachycardia	I-Application
is	O
thought	O
to	O
result	O
in	O
palpitations	B-Algorithm
with	O
abrupt	O
onset	O
and	O
abrupt	O
termination	O
.	O
</s>
<s>
In	O
patients	O
who	O
can	O
terminate	O
their	O
palpitations	B-Algorithm
with	O
a	O
Valsalva	O
maneuver	O
,	O
this	O
is	O
thought	O
to	O
indicate	O
possibly	O
a	O
supraventricular	B-Algorithm
tachycardia	I-Algorithm
.	O
</s>
<s>
Palpitations	B-Algorithm
associated	O
with	O
chest	O
pain	O
may	O
suggest	O
myocardial	O
ischemia	O
.	O
</s>
<s>
Lastly	O
,	O
when	O
lightheadedness	O
or	O
syncope	O
accompanies	O
the	O
palpitations	B-Algorithm
,	O
ventricular	B-Application
tachycardia	I-Application
,	O
supraventricular	B-Algorithm
tachycardia	I-Algorithm
,	O
or	O
other	O
arrhythmias	B-Application
should	O
be	O
considered	O
.	O
</s>
<s>
The	O
diagnosis	O
is	O
usually	O
not	O
made	O
by	O
a	O
routine	O
medical	O
examination	O
and	O
scheduled	O
electrical	O
tracing	O
of	O
the	O
heart	O
's	O
activity	O
(	O
ECG	B-Application
)	O
because	O
most	O
people	O
cannot	O
arrange	O
to	O
have	O
their	O
symptoms	O
be	O
present	O
while	O
visiting	O
the	O
hospital	O
.	O
</s>
<s>
Nevertheless	O
,	O
findings	O
such	O
as	O
a	O
heart	O
murmur	O
or	O
an	O
abnormality	O
of	O
the	O
ECG	B-Application
might	O
be	O
indicative	O
of	O
probable	O
diagnosis	O
.	O
</s>
<s>
In	O
particular	O
,	O
ECG	B-Application
changes	O
that	O
are	O
associated	O
with	O
specific	O
disturbances	O
of	O
the	O
heart	B-Algorithm
rhythm	I-Algorithm
may	O
be	O
noticed	O
;	O
thus	O
physical	O
examination	O
and	O
ECG	B-Application
remain	O
important	O
in	O
the	O
assessment	O
of	O
palpitation	B-Algorithm
.	O
</s>
<s>
An	O
irregular	O
rhythm	O
indicates	O
atrial	B-Application
fibrillation	I-Application
or	O
atrial	O
flutter	O
.	O
</s>
<s>
Blood	O
tests	O
,	O
particularly	O
tests	O
of	O
thyroid	O
gland	O
function	O
,	O
are	O
also	O
important	O
baseline	O
investigations	O
(	O
an	O
overactive	O
thyroid	O
gland	O
is	O
a	O
potential	O
cause	O
for	O
palpitations	B-Algorithm
;	O
the	O
treatment	O
,	O
in	O
that	O
case	O
,	O
is	O
to	O
treat	O
the	O
thyroid	O
gland	O
over-activity	O
)	O
.	O
</s>
<s>
The	O
next	O
level	O
of	O
diagnostic	O
testing	O
is	O
usually	O
24-hour	O
(	O
or	O
longer	O
)	O
ECG	B-Application
monitoring	O
,	O
using	O
a	O
recorder	O
called	O
a	O
Holter	O
monitor	O
,	O
which	O
can	O
record	O
the	O
ECG	B-Application
continuously	O
during	O
a	O
24-hour	O
or	O
48-hour	O
period	O
.	O
</s>
<s>
If	O
symptoms	O
occur	O
during	O
monitoring	O
it	O
is	O
a	O
simple	O
matter	O
to	O
examine	O
the	O
ECG	B-Application
recording	O
and	O
see	O
what	O
the	O
cardiac	B-Algorithm
rhythm	I-Algorithm
was	O
at	O
the	O
time	O
.	O
</s>
<s>
A	O
continuous-loop	O
event	O
recorder	O
monitors	O
the	O
ECG	B-Application
continuously	O
,	O
but	O
only	O
saves	O
the	O
data	O
when	O
the	O
wearer	O
activates	O
it	O
.	O
</s>
<s>
Once	O
activated	O
,	O
it	O
will	O
save	O
the	O
ECG	B-Application
data	O
for	O
a	O
period	O
of	O
time	O
before	O
the	O
activation	O
and	O
for	O
a	O
period	O
of	O
time	O
afterwards	O
–	O
the	O
cardiologist	O
who	O
is	O
investigating	O
the	O
palpitations	B-Algorithm
can	O
program	O
the	O
length	O
of	O
these	O
periods	O
.	O
</s>
<s>
This	O
recorder	O
is	O
implanted	O
under	O
the	O
skin	O
on	O
the	O
front	O
of	O
the	O
chest	O
,	O
like	O
a	O
pacemaker	B-Device
.	O
</s>
<s>
The	O
heart	O
in	O
most	O
people	O
with	O
palpitation	B-Algorithm
is	O
completely	O
normal	O
in	O
its	O
physical	O
structure	O
,	O
but	O
occasionally	O
abnormalities	O
such	O
as	O
valve	O
problems	O
may	O
be	O
present	O
.	O
</s>
<s>
Usually	O
,	O
but	O
not	O
always	O
,	O
the	O
cardiologist	O
will	O
be	O
able	O
to	O
detect	O
a	O
murmur	O
in	O
such	O
cases	O
,	O
and	O
an	O
ultrasound	O
scan	O
of	O
the	O
heart	O
(	O
echocardiogram	B-Application
)	O
will	O
often	O
be	O
performed	O
to	O
document	O
the	O
heart	O
's	O
structure	O
.	O
</s>
<s>
A	O
12-lead	O
electrocardiogram	B-Application
must	O
be	O
performed	O
on	O
every	O
patient	O
complaining	O
of	O
palpitations	B-Algorithm
.	O
</s>
<s>
The	O
presence	O
of	O
Q	O
waves	O
may	O
indicate	O
a	O
prior	O
myocardial	O
infarction	O
as	O
the	O
etiology	O
of	O
the	O
palpitations	B-Algorithm
,	O
and	O
a	O
prolonged	O
QT	O
interval	O
may	O
indicate	O
the	O
presence	O
of	O
the	O
long	O
QT	O
syndrome	O
.	O
</s>
<s>
Most	O
patients	O
have	O
benign	O
conditions	O
as	O
the	O
etiology	O
for	O
their	O
palpitations	B-Algorithm
.	O
</s>
<s>
The	O
goal	O
of	O
further	O
evaluation	O
is	O
to	O
identify	O
those	O
patients	O
who	O
are	O
at	O
high	O
risk	O
for	O
an	O
arrhythmia	B-Application
.	O
</s>
<s>
Echocardiograms	B-Application
are	O
indicated	O
for	O
patients	O
in	O
whom	O
structural	O
heart	O
disease	O
is	O
a	O
concern	O
.	O
</s>
<s>
Further	O
diagnostic	O
testing	O
is	O
recommended	O
for	O
those	O
in	O
whom	O
the	O
initial	O
diagnostic	O
evaluation	O
(	O
history	O
,	O
physical	O
examination	O
,	O
and	O
EKG	B-Application
)	O
suggest	O
an	O
arrhythmia	B-Application
,	O
those	O
who	O
are	O
at	O
high	O
risk	O
for	O
an	O
arrhythmia	B-Application
,	O
and	O
those	O
who	O
remain	O
anxious	O
to	O
have	O
a	O
specific	O
explanation	O
of	O
their	O
symptoms	O
.	O
</s>
<s>
People	O
considered	O
to	O
be	O
at	O
high	O
risk	O
for	O
an	O
arrhythmia	B-Application
include	O
those	O
with	O
organic	O
heart	O
disease	O
or	O
any	O
myocardial	O
abnormality	O
that	O
may	O
lead	O
to	O
serious	O
arrhythmias	B-Application
.	O
</s>
<s>
There	O
are	O
three	O
types	O
of	O
ambulatory	O
EKG	B-Application
monitoring	O
devices	O
:	O
Holter	O
monitor	O
,	O
continuous-loop	O
event	O
recorder	O
,	O
and	O
an	O
implantable	O
loop	O
recorder	O
.	O
</s>
<s>
Also	O
,	O
because	O
the	O
person	O
triggers	O
the	O
device	O
when	O
he/she	O
feel	O
the	O
symptoms	O
,	O
they	O
are	O
more	O
likely	O
to	O
record	O
data	O
during	O
palpitations	B-Algorithm
.	O
</s>
<s>
An	O
implantable	O
loop	O
recorder	O
is	O
a	O
device	O
that	O
is	O
placed	O
subcutaneously	O
and	O
continuously	O
monitors	O
for	O
cardiac	B-Application
arrhythmias	I-Application
.	O
</s>
<s>
An	O
implantable	O
loop	O
recorder	O
is	O
a	O
device	O
that	O
is	O
placed	O
subcutaneously	O
and	O
continuously	O
monitors	O
for	O
the	O
detection	O
of	O
cardiac	B-Application
arrhythmias	I-Application
.	O
</s>
<s>
Electrophysiology	O
testing	O
enables	O
a	O
detailed	O
analysis	O
of	O
the	O
underlying	O
mechanism	O
of	O
the	O
cardiac	B-Application
arrhythmia	I-Application
as	O
well	O
as	O
the	O
site	O
of	O
origin	O
.	O
</s>
<s>
EPS	O
studies	O
are	O
usually	O
indicated	O
in	O
those	O
with	O
a	O
high	O
pretest	O
likelihood	O
of	O
a	O
serious	O
arrhythmia	B-Application
.	O
</s>
<s>
Treating	O
palpitation	B-Algorithm
will	O
depend	O
on	O
the	O
severity	O
and	O
cause	O
of	O
the	O
condition	O
.	O
</s>
<s>
Radiofrequency	O
ablation	O
can	O
cure	O
most	O
types	O
of	O
supraventricular	B-Algorithm
and	O
many	O
types	O
of	O
ventricular	B-Application
tachycardias	I-Application
.	O
</s>
<s>
While	O
catheter	O
ablation	O
is	O
currently	O
a	O
common	O
treatment	O
approach	O
,	O
there	O
have	O
been	O
advances	O
in	O
stereotactic	O
radioablation	O
for	O
certain	O
arrythmias	B-Application
.	O
</s>
<s>
This	O
technique	O
is	O
commonly	O
used	O
for	O
solid	O
tumors	O
and	O
has	O
been	O
applied	O
with	O
success	O
in	O
management	O
of	O
difficult	O
to	O
treat	O
Ventricular	B-Application
Tachycardia	I-Application
and	O
Atrial	B-Application
Fibrillation	I-Application
.	O
</s>
<s>
The	O
most	O
challenging	O
cases	O
involve	O
palpitations	B-Algorithm
that	O
are	O
secondary	O
to	O
supraventricular	B-Algorithm
or	O
ventricular	B-Error_Name
ectopy	I-Error_Name
or	O
associated	O
with	O
normal	O
sinus	O
rhythm	O
.	O
</s>
<s>
These	O
conditions	O
are	O
thought	O
to	O
be	O
benign	O
,	O
and	O
the	O
management	O
involves	O
reassurance	O
of	O
the	O
patient	O
that	O
these	O
arrhythmias	B-Application
are	O
not	O
life-threatening	O
.	O
</s>
<s>
People	O
who	O
present	O
to	O
the	O
emergency	O
department	O
who	O
are	O
asymptomatic	O
,	O
with	O
unremarkable	O
physical	O
exams	O
,	O
have	O
non-diagnostic	O
EKGs	B-Application
and	O
normal	O
laboratory	O
studies	O
,	O
can	O
safely	O
be	O
sent	O
home	O
and	O
instructed	O
to	O
follow	O
up	O
with	O
their	O
primary	O
care	O
provider	O
or	O
cardiologist	O
.	O
</s>
<s>
Patients	O
whose	O
palpitations	B-Algorithm
are	O
associated	O
with	O
syncope	O
,	O
uncontrolled	O
arrhythmias	B-Application
,	O
hemodynamic	O
compromise	O
,	O
or	O
angina	O
should	O
be	O
admitted	O
for	O
further	O
evaluation	O
.	O
</s>
<s>
Palpitation	B-Algorithm
that	O
is	O
caused	O
by	O
heart	O
muscle	O
defects	O
will	O
require	O
specialist	O
examination	O
and	O
assessment	O
.	O
</s>
<s>
Palpitation	B-Algorithm
that	O
is	O
caused	O
by	O
vagus	O
nerve	O
stimulation	O
rarely	O
involves	O
physical	O
defects	O
of	O
the	O
heart	O
.	O
</s>
<s>
Such	O
palpitations	B-Algorithm
are	O
extra-cardiac	O
in	O
nature	O
,	O
that	O
is	O
,	O
palpitation	B-Algorithm
originating	O
from	O
outside	O
the	O
heart	O
itself	O
.	O
</s>
<s>
Accordingly	O
,	O
vagus	O
nerve	O
induced	O
palpitation	B-Algorithm
is	O
not	O
evidence	O
of	O
an	O
unhealthy	O
heart	O
muscle	O
.	O
</s>
<s>
Treatment	O
of	O
vagus	O
nerve	O
induced	O
palpitation	B-Algorithm
will	O
need	O
to	O
address	O
the	O
cause	O
of	O
irritation	O
to	O
the	O
vagus	O
nerve	O
or	O
the	O
parasympathetic	O
nervous	O
system	O
generally	O
.	O
</s>
<s>
It	O
is	O
of	O
significance	O
that	O
anxiety	O
and	O
stress	O
are	O
strongly	O
associated	O
with	O
increased	O
frequency	O
and	O
severity	O
of	O
vagus	O
nerve	O
induced	O
palpitation	B-Algorithm
.	O
</s>
<s>
Direct-to-consumer	O
options	O
for	O
monitoring	O
heart	O
rate	O
and	O
heart	O
rate	O
variability	O
have	O
become	O
increasingly	O
prevalent	O
using	O
smartphones	B-Application
and	O
smartwatches	B-Application
.	O
</s>
<s>
These	O
monitoring	O
systems	O
have	O
become	O
increasingly	O
validated	O
and	O
may	O
help	O
provide	O
early	O
identification	O
for	O
those	O
at	O
risk	O
for	O
a	O
serious	O
arrhythmia	B-Application
such	O
as	O
atrial	B-Application
fibrillation	I-Application
.	O
</s>
<s>
Palpitations	B-Algorithm
can	O
be	O
a	O
very	O
concerning	O
symptom	O
for	O
people	O
.	O
</s>
<s>
The	O
etiology	O
of	O
the	O
palpitations	B-Algorithm
in	O
most	O
patients	O
is	O
benign	O
.	O
</s>
<s>
People	O
who	O
are	O
determined	O
to	O
be	O
at	O
high	O
risk	O
for	O
palpitations	B-Algorithm
of	O
serious	O
or	O
life-threatening	O
etiologies	O
require	O
a	O
more	O
extensive	O
workup	O
and	O
comprehensive	O
management	O
.	O
</s>
<s>
Partnership	O
with	O
the	O
people	O
who	O
have	O
the	O
chief	O
complaint	O
of	O
palpitation	B-Algorithm
,	O
using	O
a	O
shared	O
decision-making	O
model	O
and	O
involving	O
an	O
interprofessional	O
team	O
including	O
a	O
nurse	O
,	O
nurse	O
practitioner	O
,	O
physician	O
assistant	O
,	O
and	O
physician	O
can	O
help	O
best	O
direct	O
therapy	O
and	O
provide	O
good	O
followup	O
.	O
</s>
<s>
Palpitations	B-Algorithm
are	O
a	O
common	O
complaint	O
in	O
the	O
general	O
population	O
,	O
particularly	O
in	O
those	O
affected	O
by	O
structural	O
heart	O
disease	O
.	O
</s>
<s>
Clinical	O
presentation	O
is	O
divided	O
into	O
four	O
groups	O
:	O
extra-systolic	O
,	O
tachycardic	B-Application
,	O
anxiety-related	O
,	O
and	O
intense	O
.	O
</s>
