Physical examination
During an episode of palpitations observe the following:
- heart rate
- co-ordination of atrial and ventricular contraction
- blood pressure
- heart sounds
- arterial pulsations
- jugular pulsations
The following is a summary of the physical findings for the major arrhythmias:
- AF - bp variable, heart sounds variable, arterial pulse - irregular, jugular pulsation - absent
- AVNT - bp - fixed, heart sounds - fixed, arterial pulse - regular, jugular pulsation - neck+
- CMT/AT - bp - fixed, heart sounds - fixed, arterial pulse - regular, jugular pulsation - neck-
- VT - bp - variable, heart sounds - variable, arterial pulse - regular, jugular pulsation - canon waves
(AF = atrial fibrillation, AVNT = atrioventricular nodal tachycardia, CMT = circus movement tachycardia, AT = atrial tachycardia, VT = ventricular tachycardia, neck+ = palp- itation felt in neck as well as chest, neck- = palpitation felt only in chest).
Patients examined when the palpitations have subsided are invariably normal (except for the signs of any underlying heart disease).
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