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Office of Education
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Caroline Bell: InterviewDr. Grey: What's the matter Caroline? Caroline: I can feel my heart pounding all the time. It used to come and go every once in a while. But this time it hasn't stopped. Dr. Grey: When did you start having this pounding heart beat? Caroline: I've been getting little attacks for about a year, but I didn't think much about it. Dr. Grey: Go on. Caroline: Sometimes it would wake me up from sleep, before sunrise. I would get up and walk around and it would go away. Or sometimes it would start out of nowhere. I could be sitting in my chair or washing the dishes. Dr. Grey: When did it start this time? Caroline: About 2 days ago. I keep waiting for it to stop. Dr. Grey: What does it feel like? Caroline: My heart's going really fast, and it jumps around. Dr. Grey: Any other symptoms? Caroline: It makes me feel weak, almost faint at times. Dr. Grey: Any pains in your chest? Caroline: No. Dr. Grey: Pains anywhere else, like your back, or arms, or neck? Caroline: No pains. Dr. Grey: Do you feel short of breath? Caroline: Maybe a little when I walk across the green. Dr. Grey: Any swelling in your feet? Caroline: No. Dr. Grey: What medications are you taking? Caroline: Just the ones you've been prescribing for my high blood pressure, hydrochlorthiazide 25 milligrams and lisinopril 20 milligrams. They've been working a lot better than the medications I took when I was in my twenties! And I take an aspirin every day, as you suggested. Dr. Grey: Caroline, how are you feeling about all of this?. Caroline: To tell you the truth, I haven't been myself for a few weeks. Will died 5 years ago yesterday. I always get a little sad this time of year. Dr. Grey: You've been having a hard time... I want to help you get rid of these palpitations. Let's get started with an examination and EKG.  The correct answer is e. Hypertension by itself does not cause palpitation.Palpitation (from the latin palpito or throb)is defined as an unpleasant awareness of the forceful or rapid beating of the heart. Patients may describe it as pounding, jumping, racing, or irregularity of the heart beat, a "flip flopping" or "rapid fluttering" in the chest, or pounding in the neck. It may be brought about by a variety of disorders involving changes in cardiac rhythm or rate, including all forms of tachycardia, ectopic beats, compensatory pauses, augmented stroke volume due to valvular regurgitation, hyperkinetic (high cardiac output) states such as anemia or anxiety, and the sudden onset of bradycardia. In the case of premature contractions the patient is more commonly aware of the postextrasystolic beat than of the premature beat itself, and it appears that it is the increased motion of the heart within the chest that is perceived. This explains why palpitation is not a characteristic feature of aortic or pulmonic stenosis or of essential or pulmonary hypertension, conditions characterized by an increased force of cardiac contraction without increased stroke volume. Some individuals in good health experience unexplained palpitations, in the absence of any of the above.(Adapted from Braumwald: Heart Disease) |
