It is of significance that anxiety and stress are strongly associated with increased frequency and severity of vagus nerve induced palpitation. Anxiety and stress reduction techniques such as meditation and massage may prove extremely beneficial to reduce or eliminate symptoms temporarily. Changing body position (e.g. sitting upright rather than lying down) may also help reduce symptoms due to the vagus nerves innervation of several structures within the body such as the GI tract, diaphragm and lungs. Prognosis
Direct-to-consumer options for monitoring heart rate and heart rate variability have become increasingly prevalent using smartphones and smartwatches. These monitoring systems have become increasingly validated and may help provide early identification for those at risk for a serious arrhythmia such as atrial fibrillation.Palpitations can be a very concerning symptom for people. The etiology of the palpitations in most patients is benign. Therefore, comprehensive workups are not indicated. However appropriate follow up with the primary care provider can provide the ability to monitor symptoms over time and determine if consultation with cardiologist is required. People who are determined to be at high risk for palpitations of serious or life-threatening etiologies require a more extensive workup and comprehensive management.Once a cause is determined, the recommendations for treatment are quite strong with moderate to high quality therapies studied. Partnership with the people who have the chief complaint of palpitation, using a shared decision-making model and involving an interprofessional team including a nurse, nurse practitioner, physician assistant, and physician can help best direct therapy and provide good followup.
Supraventricular and ventricular tachycardia is thought to result in palpitations with abrupt onset and abrupt termination. In patients who can terminate their palpitations with a Valsalva maneuver, this is thought to indicate possibly a supraventricular tachycardia. Palpitations associated with chest pain may suggest myocardial ischemia. Lastly, when lightheadedness or syncope accompanies the palpitations, ventricular tachycardia, supraventricular tachycardia, or other arrhythmias should be considered.The diagnosis is usually not made by a routine medical examination and scheduled electrical tracing of the hearts activity (ECG) because most people cannot arrange to have their symptoms be present while visiting the hospital. Nevertheless, findings such as a heart murmur or an abnormality of the ECG might be indicative of probable diagnosis. In particular, ECG changes that are associated with specific disturbances of the heart rhythm may be noticed; thus physical examination and ECG remain important in the assessment of palpitation. Moreover, a complete physical exam should be performed including vital signs (with orthostatic vital signs), cardiac auscultation, lung auscultation, and examination of extremities. A patient can tap out the rhythm to help demonstrate what they felt previously, if they are not currently experiencing the symptoms.Positive orthostatic vital signs may indicate dehydration or an electrolyte abnormality. A mid-systolic click and heart murmur may indicate mitral valve prolapse. A harsh holo-systolic murmur best heard at the left sternal border which increases with Valsalva may indicate hypertrophic obstructive cardiomyopathy. An irregular rhythm indicates atrial fibrillation or atrial flutter.