How to Stop Heart Palpitations

Palpitations No More

Here are some of things included in the eBook, which you can download right now as a Pdf: Why no one else has offered you an effective solution so far. What the 3 most common reasons and treatment options are, and why they dont work. The 5 most common root causes of palpitations and how you can correct each one. How physical, mental, emotional problems can cause palpitations and how these can be prevented and corrected. How your diet can cause palpitations and how you can correct this to get results in as little as 24 hours. How a single little misalignment in your body can cause palpitations and other havoc, and how you can get this corrected. Learn how and why panic attacks develop and how you can use a simple technique to prevent them from occurring. and many other general health solutions.

Palpitations No More Summary


4.6 stars out of 11 votes

Contents: EBook
Author: Mikael Sundman
Price: $47.00

My Palpitations No More Review

Highly Recommended

Recently several visitors of blog have asked me about this ebook, which is being advertised quite widely across the Internet. So I decided to buy a copy myself to find out what all the fuss was about.

All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Download Now


Palpitations are the uncomfortable sensations in the chest associated with a range of arrhythmias. Patients may describe palpitations as ''fluttering,'' ''skipped beats,'' ''pounding,'' ''jumping,'' ''stopping,'' or ''irregularity.'' Determine whether the patient has had similar episodes and what was done to extinguish them. Palpitations are common and do not necessarily indicate serious heart disease. Any condition in which there is an increased stroke volume, as in aortic regurgitation, may be associated with a sensation of ''forceful contraction.'' When a patient complains of palpitations, ask the following questions ' 'How long have you had palpitations '' ' 'Have you noticed palpitations after strenuous exercise on exertion while lying on your left side after a meal when tired '' ''During the palpitations, have you ever fainted had chest pain '' ''Was there an associated flush, headache, or sweating associated with the palpitations ''* Have you noticed an intolerance to heat cold...

Anxiety and Obsessive Compulsive Disorder Syndromes

Anxiety is an extremely common occurrence that affects everyone at some time and is characterized by an unpleasant and unjustified sense of fear that is usually associated with autonomic symptoms including hypervigilance, palpitations, sweating, lightheadedness, hyperventilation, diarrhea, and urinary frequency as well as fatigue and insomnia. Anxiety is thought to be mediated through the limbic system, particularly the cingulate gyrus and the septal-hippocampal pathway, as well as the frontal and temporal cortex. The term anxiety disorder is used to denote significant distress and dysfunction resulting from anxiety, including panic attacks and anxiety with specific phobias. Chronic, moderately severe anxiety tends to run in families and may be associated with other anxiety disorders or depression. The differential diagnosis of anxiety states includes other psychiatric conditions such as anxious depression as well as schizophrenia, which may present as a panic attack with disordered...


One day many years ago, when the risk manager from my hospital knocked on my door asking for a patient's chart, I experienced palpitations. The case involved a patient who had been seen because she had a child with a chromosome abnormality. She wanted and had an amniocentesis. When the laboratory reported an elevated amniotic fluid alpha-fetoprotein level, I had arranged for a targeted ultrasound scan at another institution. The level of ultrasound scan needed was only offered by a few experienced centers at that time.

The Symptoms of Pregnancy and Warning Signs of Cardiac Disease

Palpitations are coupled with extreme elevations in heart rate, or with lightheadedness, fainting, or chest pain, should a potentially dangerous heart rhythm be suspected. Outpatient heart rhythm monitoring can rule out an abnormality and reassure both patient and physician. If an abnormality is detected and treatment is considered, there are multiple available and safe therapies.

Written History of Mr John

History of Current Illness This is the first St. Catherine's Hospital admission for Mr. John Doe, a 42-year-old lawyer with coronary artery disease. His history dates back to approximately 4 years before admission, when he started to experience a vague discomfort in his chest. He describes it as ''a dull ache,'' provoked by emotional upsets at work. He suffered his first heart attack on July 15, 2008, while playing tennis. He was hospitalized for 3 weeks in Kings Hospital. After 3 weeks at home, he returned to work. Six months later, he suffered his second heart attack, again while playing tennis. He was again hospitalized at Kings Hospital and was told that he had ''irregularity'' of his heart. He was started on some medications for this irregularity. The patient denies any palpitations since then.

Fibromyalgia Tired of Being Sick and Tired

Myalgia (muscle pain) characterizes this often-devastating chronic rheumatic pain disorder of unknown cause. The pain is usually described as achy but a few patients tell me they can also experience burning, throbbing, stabbing, or shooting pain. To make this dish sound even more appetizing, fibromyalgia is often accompanied by side orders of chronic headaches, strange skin sensations, temporomandibular joint pain (TMJ), insomnia, irritable bowel syndrome (IBS), anxiety, palpitations, fatigue, poor memory, painful menstruation, and depression.

Primary Anxiety Disorders

Ated in children and adolescents with comorbid medical conditions that may also be associated with somatic symptoms. The psychological symptoms of anxiety are routinely associated with physical signs of autonomic activity (e.g., palpitations, shortness of breath, tremulousness, flushing, faintness, dizziness, chest pain, dry mouth, muscle tension). The most common somatic symptoms reported by children and adolescents with DSM-IV-TR anxiety disorders (i.e., social, separation, and generalized anxiety disorders) were as follows restlessness (74 ), stomachaches (70 ), blushing (51 ), palpitations (48 ), muscle tension (45 ), sweating (45 ), and trembling shaking (43 ) (Ginsburg et al. 2006).

Why See a Cardiologist

In some cases, the cause of the chest pain is known to be coronary artery disease, and the referral is made for more advanced diagnostic testing and treatment in other cases, the cause of the chest pain is unknown. Other common reasons for referral include shortness of breath, congestive heart failure not responsive to standard medical treatment, irregularities in the heart rhythm, blackout episodes (syncope), or palpitations.

Typical Diagnostic Tests

If your abnormality includes your heart rhythm, a Holter monitor is quite valuable. This is a small device the size of a transistor radio that records your ECG for a day or two while you record any symptoms you may have in a diary. If the palpitations or lightheaded episodes that bring you to the cardiologist occur only once in a while, an event monitor may be utilized. You can take this monitor home and call a station where heart rhythm detection occurs through a telephone monitor.

Dimensions And Syndromes

Where anxiety is concerned, frightened and nervous apprehension is at the heart of the syndrome and constitutes its essential feature. The associated symptoms involve autonomic hyperactivity such as palpitations and cold sweats, motor tension such as trembling and muscle-twitching, and vigilance such as being keyed-up or easily startled. Where depression is concerned, the essential features involve dysphoria and anhedonia (the former referring to pervasive sadness and the latter to loss of interest and pleasure) and the associated symptoms involve disturbances of sleep, appetite, energy, and concentration as well as lack of self-esteem and thoughts about death and suicide.

Course Of Panic Disorder

Visits being precipitated by physical sensations associated with panic disorder, such as dizziness, heart palpitations, chest pain, dyspnea, and abdominal pain, as demonstrated by both epidemiological and retrospective studies (Katon, 1996). Patients with panic disorder account for 20 to 29 percent of all emergency room visits (Swenson et al., 1992 Weissman et al., 1989) and are 12.6 times more likely to visit emergency rooms than the general population (Markowitz et al., 1989).

Morita SR DePalma M Arad B McDonough S Barr C Duffy BJ Maron CE Seidman and JG Seidman

Hypertrophic cardiomyopathy (HCM) is a genetically heterogeneous autosomal dominant trait, in which affected individuals develop left ventricular hypertrophy or thickening of the heart wall (Fig. 1) (for reviews, see Fatkin et al. 2000 Towbin 2000 Seidman and Seidman 2001). Although affected individuals may live for many years without obvious clinical signs of their disease, many of these individuals go on to develop chest pain, dyspnea, palpitations, and even sudden death. Associated with cardiac hypertrophy, heart muscle from affected individuals demonstrates myocyte disarray and fibrosis (Fig. 2). Eleven different disease genes have been identified, including -cardiac myosin (MHC) (Geisterfer-Lowrance et al. 1990), cardiac actin (Olson et al. 2000), a-tropomyosin (Thierfelder et al. 1994), cardiac troponin T (TNT Thierfelder et al. 1994), cardiac myosin-binding protein C (MyBP-C Watkins et al. 1995), essential myosin light chain (MLC Poetter et al. 1996), regulatory myosin light...

Panic Disorder Definition

The key feature of panic disorder in DSM-III is the occurrence of three or more panic attacks within a three week period. These attacks cannot be precipitated only by exposure to a feared situation, cannot be due to a physical disorder, and must be accompanied by at least four of the following symptoms dyspnea, palpitations, chest pain, smothering or choking, dizziness, feelings of unreality, paresthesias, hot and cold flashes, sweating, faintness, trembling or shaking (APA, 1980). In DSM-III-R, the definition was revised to require four attacks in four weeks or one or more attacks followed by a persistent fear of having another attack. In DSM-III-R, the list of potential symptoms was revised to include nausea or abdominal distress and to exclude depersonalization or derealization (APA, 1987).

Ecg Tracing Of Normal Heart Rhythm

Palpitations Palpitations are an awareness of unusually rapid, strong, or irregular beating of the heart. It is normal for the heart rate to speed up during strenuous exercise, and you may feel your heart thumping for some minutes afterwards. This is usually no cause for concern. In most cases, palpitations that occur at rest are caused by the effect of drugs such as caffeine or nicotine or may simply be due to anxiety. However, in a small proportion of people, palpitations that occur at rest are a symptom of an underlying illness. If you have recurrent palpitations that have no obvious cause or that are associated with chest pain or shortness of breath, you should always seek medical advice.

Maass JP Konhilas BL Stauffer and LA Leinwand

Familial hypertrophic cardiomyopathy (FHC) is a heterogeneous disease with variable phenotypes caused by autosomal-dominant mutations in one of several contractile proteins (Roberts and Sigwart 2001a). The mutations typically lead to myocyte hypertrophy, myocellular myofibrillar disarray, increased interstitial collagen, and hypertrophy in small arteries (Wigle et al. 1995). FHC is estimated to have a prevalence of about 0.2 in the population of young adults as recognized by echocardiography (Maron et al. 1995) and is the most common cause of sudden death in adolescents and young adults, especially in athletes. Clinical symptoms can include dyspnea, palpitations, chest pain, sudden death, or severe heart failure, whereas many other patients remain asymptomatic (Maron 1997). As of yet, no specific therapy is available for this disease, with only symptomatic treatments for aspects of the syndrome (Roberts and Sig-wart 2001b).

Benign Tumors Pheochromocytoma

Pheochromocytomas are rare benign tumors characterized by the abnormal proliferation of the adrenal chromaffin cells derived from the primitive neuroectoderm. As a result, a high level of catecholamine is produced. Ninety percent of these tumors are found in the adrenal medulla of the kidney. They may be associated with neurofibromatosis, von Hippel-Lindau disease, tuberous sclerosis, Sturge-Weber syndrome, and as a component of the multiple endocrine neoplasm syndrome, which is briefly described in the section on mucosal neuroma. Hypertension, whether sustained or episodic, is the most common clinical sign of pheochromocytomas. Headache, excessive truncal sweating, and palpitations are also commonly observed in these patients.78 The diagnosis of these tumors includes assaying for serum and 24-hour urine catecholamines, as well as their metabolites such as vanillylmandelic acid (VMA) and metanephrines. Malignant transformation, by local invasion or metastasis, occurs in 10 of patients...

Decision to Prescribe Medicotion

Dr. li, a third-year candidate, had been treating Mr. Y in psychoanalysis for I year when Mr. Y began to complain of severe anxiety attacks. The onset of these attacks coincided with Mr. Y's graduation from law school and his preparation for taking the bar exam. Dr B explored the meaning of graduation to Mr. Y, whose father was die-managing partner in a large law firm, and interpreted Mr. Y's conflicts about studying law. Despite these interventions, Mr. Y's anxiety attacks worsened. Mr. Y complained to Dr. B that he was having palpitations that woke him from sleep and said that he feared that lie was having a heart attack. Dr. B wondered whether Mr. Y might be suffering from panic disorder but was confused about the extent to which the psychodynamic issues might be producing the anxiety. I le was alraid to approach his supervisor with this issue, fearing that his supervisor might think that lie was not thinking like a psychoanalyst and worrying that treating the patient with...

Lower Gastrointestinal Bleeding

Lower GI bleeding (LGIB) is defined as bleeding arising from a source distal to the ligament of Treitz, with the resultant potential for rapid hemodynamic instability. Physical signs of hemodynamic compromise include orthostatic hypotension, fatigue, pallor, palpitations, chest pain, dyspnea, tachypnea, and tachycardia. Hemodynamic stabilization through large-bore IV fluid resuscitation should be initiated

Clinical Features

Headache, sweating, palpitations, and paroxysmal hypertension is prototypical of these symptoms.12 The hypertension may be so severe that peripheral blood pressure measurements may be difficult to obtain because of the extreme vasoconstriction. Cardiac decompensation suggestive of acute myocardial infarction can also occur, sometimes precipitated by partial necrosis of the tumor with sudden release of a bolus of epinephrine and norepinephrine into the bloodstream (Fig. 71-1).

Depression Checklist Are You at Risk

One of the most common diagnoses in traditional Oriental Medicine is heart-blood deficiency As you can tell by the name, this condition deals with issues concerning the heart organ or channel. These issues are usually emotional. Blood deficiency implies an energetic weakness. This usually presents itself as palpitations, insomnia, poor memory, dizziness, jumpiness, dull complexion, confusion, and lack of concentration.

Hypertension The Pressures On

Blood pressure is measured by a sphygmomanometer. A normal reading is about 120 80 a reading of 140 90 measured at least on two office visits is officially considered high blood pressure. Hypertension rarely exhibits symptoms, so it's often called the silent killer. Left untreated, high blood pressure can lead to serious conditions such as vision problems, heart attack, stroke, or kidney failure. If early symptoms do occur, they may include headaches, sweating, muscle cramping, palpitations, rapid pulse rate, dizziness, vision problems, or shortness of breath. Having your blood pressure checked every four to six months is an easy precaution to ensure your pressure is staying on course.

Clinical Presentation

Atrial fibrillation complicates the course of approximately 20 of patients with HCM and is associated with an increased risk of heart failure-related death.21,28 The risk seems to be substantially greater in the subset of patients with outflow tract obstruction or an earlier onset of arrhythmia (< 50 years of age). Advancing age, left atrial enlargement, and congestive symptoms are independently linked to the development of atrial fibrillation. Although atrial fibrillation is strongly associated with an increased risk of fatal and nonfatal stroke, it does not appear to be a risk factor for the development of SCD, and approximately one third of patients have no long-term sequelae from this arrhythmia.28 Severe functional deterioration due to dyspnea, chest pain, palpitations, or pulmonary edema may complicate the course of the chronically affected. These symptoms are most likely caused by the loss of atrial contraction, reduction in diastolic filling time, and exacerbation of...

Clinical Presentation and Diagnosis

ASDs typically cause no symptoms during the first 2 decades of life. Diagnosis is most often made after detection of a murmur, indistinguishable from that of pulmonary valve stenosis, or with auscultation of a fixed, split second heart sound.98 Infrequently, infants or children present with failure to thrive or other more overt signs of congestive heart failure, or with recurrent lower respiratory tract infections. Later, in the third and fourth decades, if previously undiagnosed, symptoms may include undue fatigue, increased dyspnea on exertion, and a frequent sensation of palpitations.97,101

Diseases of Antiquity in Japan

Beriberi, a disease caused by thiamine deficiency and often associated with cultures that relied on rice as staple food, was endemic in Japan. It was called, alternatively, kakke, kakubyo, or ashinoke, the latter meaning illness of the legs. The oldest record of beriberi in Japan refers to the son of the Emperor Shomu, who died of this disease in A.D. 744, at the age of 17 years. The Ishinpo, compiled one and a half centuries later, contains a detailed description of the symptoms, such as pain, paralysis of the legs, anasarca, and palpitations.

Painful de Quervains Thyroiditis

The disorder classically progresses through four stages.24 The initial hyperthyroid phase, due to release of thyroid hormone, lasts 3 to 6 weeks and may be accompanied by symptoms such as tremors, sweating, palpitations, and heat intolerance in 50 to 70 of patients. Patients then progress to the second or euthyroid phase. Hypothyroidism, which is the hallmark of the third phase, occurs in about 20 to 30 of patients and lasts from weeks to months. The last phase is characterized by resolution of the disease and returns to the euthyroid state in more than 90 of patients. Of note, some patients may progress directly from the hyperthyroid phase to the recovery phase, without the intervening hypothyroid phase. A few patients develop recurrent disease.

Migraine Dizziness and Orthostatic Intolerance OI

Orthostatic intolerance (OI) covers a spectrum of symptoms including presyncope and syncope, weakness and fatigue, tachycardia or palpitations, nausea, and difficulty concentrating. Symptoms can be aggravated by prolonged standing, physical exertion, environmental warming, post-prandial states, and menses. Diagnosis is based on history and results of heads-up tilt table testing. Postural orthostatic tachycardia syndrome is thought to be associated with abnormal venous pooling and fluid collection in the lower extremities. Symptoms that often accompany POTS are tachycardia, hypotension, dizziness, fatigue, palpitations, and nausea.

Bradycardia and tachycardia

Tachycardia is defined as a heart rate > 100 beats per minute. Like bradycardia, tachycardia may be caused by non-cardiac and cardiac causes. Non-cardiac causes of tachycardia in stroke patients comprise fever, hypovolemia, anemia, hyperthyroidism, pulmonary embolism, pain, alcohol withdrawal, broncho-spasm, side-effects of drugs and rebound in patients previously treated with beta-blocking agents. Cardiac causes of tachycardia are the same as for bradycardia, and the clinical consequences range from palpitations to sudden cardiac death.

Basic Principles of Geriatric Medicine

First, there is an altered manifestation ofdisease. The actual symptom may not be a symptom of the organ system involved with the disease. For example, if a person in his or her 50s were to have a heart attack, the individual, unless diabetic, would usually suffer from chest pain. This is not the case in the geriatric age group. It is well documented that 70 of nondiabetic individuals older than 70 years of age do not have chest pain with a myocardial infarction. Such patients may present instead with breathlessness, falling, confusion, or palpitations.

Neoplastic Neck Masses

Carotid body tumors are paragangliomas that arise from the adventitia of the common carotid bifurcation. They are thought to arise from derivatives of neural crest cells and are members of the diffuse neuroendocrine system. They can be associated with other tumors of similar origin, including medullary thyroid carcinoma, parathyroid adenoma, and pheochromocytoma, in up to 7 of cases. Familial incidence is 8 to 10 , and inheritance is autosomal dominant. A high incidence of bilateral carotid body tumors occurs in familial paraganglioma syndromes, and 1 to 3 of these tumors actively secrete substances such as catecholamines or serotonin. Symptoms of catecholamine secretion include headache, perspiration, palpitations, pallor, and nausea. Screening for blood and urinary catecholamines should be performed to rule out a secreting tumor or pheochromocy-toma. Symptoms of serotonin secretion are carcinoid syndrome, including diarrhea, flushing, severe headaches, and hypertension.

Clarks cognitive model of panic

Clark's elegantly simple model of panic owes much to the ideas of Beck (e.g., 1976) which are discussed in detail in Chapter 4. According to Clark's (1986, 1996) model of panic catastrophic misinterpretations of certain bodily sensations (1986, p. 461) are a necessary condition for the production of a panic attack. Thus, a panic attack may originate from the misinterpretation that an increase in heart rate is a signal for an impending heart attack, or that the onset of feeling slightly dizzy or flushed is a sign that the individual is about to faint. Although such bodily sensations are symptoms of fear, and consequently Clark's model can be thought of as an extension of the fear of fear hypothesis, such sensations are not uniquely associated with fear. So, for example, heart palpitations may result from excessive caffeine intake or exercise rather than from an interpretation or appraisal related to threat. The point, then, is The specific sequence of events that Clark suggests occur...

Specific Etiological Types of Mitral Regurgitation

The disorder, when it occurs in the idiopathic form, may be characterized by symptoms that have no particular relationship to the degree or severity of the mitral regurgitation. The patients may present for reason of chest pains, palpitations, or abnormal T waves on the electrocardiogram, arrhythmias, or simply because of the characteristic auscultatory features. They may exhibit certain skeletal abnormalities, such as scoliosis, significant laxity ofjoints, and a high-arched palate. In some patients with chest pain in this condition, abnormal lactate uptake has been demonstrated, and in some coronary spasm has also been shown. Some patients may have transient embolic symptoms because of platelet thrombi forming between the hooded leaflets and the left atrial wall underneath it. Rarely, infective endocarditis may develop. In view of the variety of symptoms that they may present with, the disorder is often described as idiopathic prolapsed mitral leaflet syndrome. The mitral...

Press Acu Points to Pause Your Menopause

Acupoints For Menopuase

The natural process of menopause has been getting comforting help from Oriental Medicine for centuries. As you've already read, diet, exercise, and a healthy outlook are key components of any comprehensive treatment plan. Hot flashes, dry skin, vaginal dryness, increased thirst, insomnia, forgetfulness, and anxiety are part of the deficient heart yin pattern in Oriental Medicine. The term deficient yin in this case often refers to the reduction in estrogen. The term heart addresses not only the organ itself, but the accompanying forgetfulness, insomnia, palpitations, and mood changes.

History and Geography

Galen of Pergamum listed several causes of dropsy in the first century A.D., including a hardened liver, as well as inadequate blood formation (which he thought occurred in the liver), hemorrhoids, and both amenorrhea and uterine hemorrhage. Virtually all writers on dropsy until the mid-seventeenth century cited the teachings of Hippocrates, Celsus, and Galen. Their ideas were also relayed in the eleventh century by Avicenna of Baghdad, who thought that the tachycardia, palpitations, pulmonary edema, dyspnea, and syncope (fainting or shock, which he postulated was a sign of a weak heart) that accompanied dropsy were related to one another. Five centuries later, the French surgeon Ambroise Par described dropsy in identical terms. His countryman Jean Fernel relied on the same theories when he associated heart disease, but not dropsy specifically, with palpitations, syncope, and the pallor, cold sweat, and weak pulse often observed in cardiogenic shock. Also in the sixteenth century,...

Diagnosis and Treatment of Dizziness and Headache

Abstract Dizziness and headache are separately quite common. There are, however, a number of scenarios where the two can be interconnected. An area of significant clinical interest at this time is migraine-associated dizziness, in which the migraine generator produces vestibular symptoms. Also, there can be an overlap between orthostatic intolerance and migraine, with a spectrum of symptoms from palpitations and tachycardia to presyncope or actual syncope. A third important area of overlap is related to mechanical syndromes of the neck, cervicogenic headache, which may overlap, occurring with vestibular symptoms. There are also a number of systemic entities that can cause both dizziness and headache covered in this chapter.

Hormone Secreting Tumors

Pheochromocytoma is a rare disorder that can occur in both children and adults and is associated with catecholamine secretion from a tumor in the renal medulla. This secretion results in acute, episodic, or chronic symptoms of anxiety that are often associated with hypertension. Clinical symptoms include increased heart rate, increased blood pressure, myo-cardial contractility, and vasoconstriction. Patients may present with headache, sweating, palpitations, apprehension, and a sense of impending doom (Goebel-Fabbri et al. 2005). A pediatric case report documents a 15-year-old with pheochromocytoma who presented with panic attacks, depression, headache, and jaundice (Gokge et al. 1991). Thyroid adenoma or carcinoma, parathyroid tumor, adreno-corticotropic hormone-producing tumors, and insulinomas are other hormone-secreting tumors associated with anxiety symptoms.

How Do Psychiatric Or Behavioral Symptoms Vary In Patients With Simple As Opposed To Complex Partial Seizures

Cold or warm sensation Pallor or flushing Piloerection Palpitations Peri-ictal symptoms experienced during partial seizure activity may include motor symptoms, such as focal clonic activity somatosensory phenomena, including unformed hallucinations and perceptual changes autonomic changes, including diaphoresis and palpitations abdominal sensations and emotional cognitive symptoms, including fear, anxiety, depression, anger, dissociation, d j vu, environmental distortions, and formed hallucinations. Figure 7.1 lists symptoms of partial seizures.

Thyroid Hormone Treatment

Is additional T3 to l-T4 beneficial The study by Bunevicius and coworkers showed improvement in neuropsychological behavior and mood by combined T4 and T3 treatment in hypothyroid patients.73 In animal models of thyroidectomized rats, the addition of T3 to T4 normalized plasma and tissue levels of thyroid hormone T4 treatment alone did not achieve such normal levels.74 However, the addition of T3 may cause palpitations and worsening angina, particularly in elderly patients. Therefore, T3 treatment should be used carefully if it is to be employed.

Associated Neurological Findings

The clinician should look for evidence of autonomic hyperactivity including the presence of palpitations, cold clammy extremities, sweating, sighing, trembling, or hypervigilance, which can be indicative of anxiety disorders, anxiety associated with neurological diseases, or drug withdrawal syndromes.

Atrial fibrillation

Loop Recorder Implant

AF is a cardiac arrhythmia, defined by the absence of P waves and varying RR distances in the electrocardiogram. AF is a common arrhythmia and its prevalence increases with age up to 9 at age 80-89 years (Figure 7.1). Approximately 85 of the individuals with AF are between 65 and 85 years of age 1 . Apart from hemodynamic consequences due to the loss of atrial contraction and symptoms, such as palpitations,

Side Effects Of Vasoconstrictors

True allergies to vasoconstrictor drugs are rare however, side effects owing to high blood concentrations are frequent. High blood levels of vasoconstrictors can manifest as tachycardia, hypertension, palpitations, headache, shortness of breath, nausea, vomiting, faintness, tremor, and anxiety.13 These side effects resemble early signs of local anesthetic toxicity and may be mistaken for local anesthetic side effects. Addition of vasoconstrictors to local anesthetics should be avoided in any tissue supplied by an end artery. Examples of tissues supplied by end arteries are the fingers, toes, and penis. Ischemia and gangrene may result from injection of epinephrine into these tissues ( Fig. 45-2 ).

Patient Encounter 1 Part 2

It is enzymatically cleaved to epinephrine. Epinephrine has a and -agonist activity and is thought to increase the outflow of aqueous humor through the trabecular mesh-work and the uveoscleral pathway. Both products are instilled twice daily and reduce IOP by 15 to 25 . Local adverse effects include mydriasis, conjunctival hyperemia, and ocular irritation. Aphakic patients should not use these medications because they cause a reversible cystoid macular edema. Epinephrine and dipivefrine should not be used in patients with narrow angles since these agents can cause acute angle closure. Systemic side effects include palpitations, increased blood pressure, and arrhythmia and, therefore, these drugs should be used with caution in patients with cardiovascular disease, cerebrovascular disease, and hyperthyroidism. Using the nasolacrimal technique may decrease systemic effects.11,

Review of Systems and Examination of the Older Child

School-aged children may have chronic somatic complaints such as headaches, stomach pain, or leg pains which often have a partly emotional basis. A good history of the circumstances in which these complaints occur can help you tease out the triggers. Other items to add to the review of systems for children aged 6 to 12 years include persistent sneezing and nasal itching, itchy eyes, snoring, disturbed sleep, daytime somnolence, chest pain, exercise-induced cough or wheezing, nocturnal cough, palpitations, polyuria, polydipsia, syncope, persistent sadness or worry, sports injuries, and concussion.

Putting the History and Physical Examination Together

Catherine's Hospital admission for this 42-year-old lawyer with atherosclerotic coronary artery disease. The patient's history of chest pain began 4 years before admission. He described the pain as a ''dull ache'' in the retrosternal area, with radiation to his left arm. The pain was provoked by exertion and emotions. On July 15, 2008, Mr. Doe suffered his first heart attack while playing tennis. He had an uneventful hospitalization in Kings Hospital in New York City. After 3 weeks in the hospital and 3 weeks at home, he returned to work. The patient suffered a second heart attack 6 months later (January 9, 2009), again while playing tennis. The patient was hospitalized in Kings Hospital, during which time he was told of an ''irregularity'' in his heart rate. Since then, the patient has not experienced any palpitations, nor has he been told of any further irregularities.

Critique of Selected Clinical Trials

An investigation of the psychophysiological effects of aromatherapy massage following cardiac surgery (Stevenson, 1994) showed experimenter bias due to the statement that neroli is also especially valuable in the relief of anxiety, it calms palpitations, has an antispasmodic effect and an anti-inflammatory effect it is useful in the treatment of hysteria, as an antidepressant and a gentle sedative. None of this has been scientifically proven, but as this was not a double-blind study and presumably the author did the massaging, communicating, and collating information alone, bias is probable. Statistical significances were not shown, nor the age ranges of the 100 patients, and no differences between the aromatherapy-only and massage-only groups were shown, except for an immediate increase in respiratory rate when the two control groups (20 min chat or rest) were compared with the aromatherapy massage and massage-only groups.

Clinical Manifestations and Pathology

A person with beriberi classically entered the medical system when he or she developed symptoms of the weakness that gave the disease its name. There was malaise, a heaviness in the lower limbs, loss of strength in the knee joint and wrist, and usually some loss of sensation. There was tightness in the chest, palpitations, restlessness, loss of appetite, and often a full feeling in the epigastrium. Infants also vomited, had diarrhea, and had difficulty breathing. Heart palpitations, even at rest, and a diastolic blood pressure below 60 millimeters of mercury are usually diagnostic. There is enlargement of the heart, particularly the right ventricle. A heart murmur may be heard. An EKG may be normal in a mild case but shows abnormal waves of sinus origin in advanced ones.

Population And What Tests Best Distinguish One Disorder From Another

Historical elements that support the diagnosis of syncope include a postural component (although even vasovagal syncope can occur in the supine position with a sufficient emotional stimulus) and premonitory symptoms, such as palpitations, warmth, diaphoresis, fading vision and hearing, nausea, and diffuse weakness. Although all these symptoms may occur during partial seizure auras, in the case of syncope they are often of more gradual onset, and the nausea associated with syncope does not typically have the rising component that is so common in seizures of mesial temporal origin. Pallor is more often noted with syncope but may also occur during limbic seizures. Diffuse stiffening or frank clonic movements may occur with syncope, particularly if the person is maintained in the head-up posi

Risk Factor Modification

Control of dyslipidemia and diabetes is also very important in the management of patients with CHF. Screening for sleep apnea and thyroid disease and aggressively treating these conditions need to be done. The avoidance of alcohol, illicit drug use, and smoking is strongly advised. Losing weight and establishing a routine exercise program are also important preventive measures in the CHF patient. Patients with a history of heart palpitations need to be evaluated for tachycardia because this is a well-established risk factor for cardiomyopa-thy and CHF. If patients have daily palpitations, a 24-hour Holter monitor is sufficient to help establish the type of arrhythmia. On the other hand, if palpitations occur infrequently (a few times per month), an event care monitor is more useful because patients can keep this type of monitor with them at home for a month and record the arrhythmia as it occurs. If palpitations are very infrequent, it is unlikely that they will be contributing to...

Warning Symptoms in Athletes

Warning or red flag symptoms that may indicate the presence of an underlying cardiovascular disorder should be recognized and further assessed before medical clearance. Syncope that occurs during but not after exercise is of great concern and warrants a comprehensive cardiology evaluation to rule out the presence of an occult cardiac disorder that may lead to sudden death. Other worrying symptoms include palpitations, chest pain, lightheaded-ness, and fatigue or dyspnea greater than expected for the level of activity. Athletes with warning symptoms should be evaluated by an electrocardiogram (ECG), echocardio-gram, and exercise stress test and referred to a cardiologist. In addition, systolic murmurs of grade 3 6 in severity, all diastolic murmurs, any murmur that becomes louder with a Valsalva maneuver or on standing (suspicious for hypertrophic cardiomyopathy), and a concerning family history of premature sudden cardiac death or hereditary cardiac disorder should be further...

Special Clinical ECG Syndromes

Sick sinus syndrome (SSS) is a group of electrocardiographic and clinical findings. Patients often have symptoms of fatigue, palpitations, and heart racing and may suffer from dizzy spells or even syncope. The findings of paroxysmal atrial tachycardia, atrial fibrillation (AF), or atrial flutter result in tachypalpitations and heart racing. Excessive SA

Mitral Valve Prolapse

Patients with MVP are often asymptomatic. However, some patients describe palpitations, chest pain, dyspnea, and fatigue with or without MR. Although previously thought that strokes occur more frequently in patients with MVP, recent data do not support this conclusion (Gilon et al., 1999). Panic attacks have been frequently described. A high-pitched midsystolic click is often heard that occurs shortly after S1 and can be associated with a systolic murmur. Baseline electrocardiography is often unrevealing, and routine stress testing carries a high false-positive rate. Stress imaging is more accurate in evaluating these patients for myocardial ischemia. An echocardiogram is the most helpful methodology for making the diagnosis of MVP. A displacement of the leaflets beyond the mitral annulus on a parasternal short axis is strongly suggestive of MVP. Cardiac catheterization is generally not needed for diagnosis.


C-vear-old man with chronic obstructive pulmonary t. sease related ti chronic smoking presents to the emergency room with palpitations. FCC shows narrow 54. A 55-year-old woman returns to the clinic after a recent dual-chamber pacemaker placement. She reports frequent palpitations and fatigue. I hese episodes last for several minutes before stopping. A Holter monitor recorded the following rhythm (fig. 1-2 The pacemaker is programmed to mode DDD lower rate, 80 bpm upper rate, 150 bpm AV delay 200 milliseconds postventricular atrial RP, 150 milliseconds. The latter part of this rhythm strip shows

Falls Assessment

Falls assessment should include a multifactorial evaluation beginning with the circumstances surrounding the fall(s), associated symptoms, risk factor assessment, and medication history (Table 4-4). The physician should ask about the environment (e.g., indoors or outdoors, dark or well lighted, time of day), environmental obstacles (e.g., throw rugs, door thresholds, stairs), and footwear worn at the time. The history should also include questions about prodromal symptoms (e.g., lightheadedness, dizziness), if there was a loss of consciousness or other symptoms of arrhythmias (i.e., palpitations). If available, obtain information from a witness. The evaluation should also include questions about risk factors, functional abilities and medication history (AGS et al., 2001).

Clinical History

When a patient has apathy or abulia, there is a near complete loss of feeling, initiative, movement, and thought. Very little historical information can be obtained directly from the patient, and the physician will have to rely on other family members or caretakers. In contrast, patients with anxiety and anxiety disorders often describe feelings of tension, irritability, or apprehension and may be mildly distractible during the interview. The presence of concomitant autonomic symptoms should be inquired about, including palpitations, diarrhea, cold clammy extremities, sweating, urinary frequency, insomnia, fatigue, and trembling.


In addition to the emotional reaction, fear can be manifested physiologically by restlessness, gastrointestinal problems, or headaches. Other common symptoms of anxiety include difficulty falling asleep, nightmares, urinary frequency, palpitations, fatigue, vague aches and pains, paresthesias, and shortness of breath. It is not uncommon for patients to feel as if they were ''falling apart.''

Pulmonary Disease

Hyperventilation syndrome occurs across the life span and presents with symptoms of anxiety such as faintness, visual disturbances, nausea, vertigo, headaches, palpitations, dyspnea, diaphoresis, and paresthesias (Coffman and Levenson 2005). The symptoms may be reproduced by observation of the patient's response to overbreathing. Hyperventilation syndrome is a form of panic disorder in which hyperventilation causes an excessive elimination of carbon dioxide and a reduction in cerebral blood flow. Research examining adolescents in laboratory settings using voluntary hyperventilation challenge


The most common presenting symptoms of pheochromo-cytoma are episodic pounding headaches, diaphoresis, palpitations or tachycardia, nervousness, and tremor these are all related to the excess catecholamine secretion from the tumor. Catecholamine excess can also cause impaired glucose tolerance and hypermetabolism. The best screening test for pheochromocytoma is a urinary metanephrine assay. If meta-nephrine values are elevated, a 24-hour urine specimen should be collected to detect metanephrine, vanillylmandelic acid, and catecholamines. Plasma catecholamine levels are unreliable, because excess catecholamine release can be paroxysmal. If a pheochromocytoma is suspected, then abdominal MRI is the most sensitive radiologic test. Surgical resection is generally curative, and because paroxysmal catecholamine excess can have dire consequences during any surgery, it is recommended that VHL-disease patients with both CNS lesions and pheochromocytoma undergo resection of the...

Preterm Labor

Terbutaline has been shown to prolong pregnancy but has not decreased neonatal morbidity.34'39 It is contraindicated in women with pre-existing cardiac arrhythmia. Common adverse effects include hyperglycemia, palpitations, tremor, nausea, headache, and chest pain. Potentially serious maternal adverse effects include pulmonary edema, cardiac arrhythmia, and myocardial ischemia. Reported fetal and neonatal adverse effects include tachycardia, hyperglycemia, and hyperinsulinemia.34


A major difference between the way a scale functions and the manner in which syndrome recognition occurs is that each symptom is treated equally in a scale. A symptom like palpitations is scored in exactly the same way as the symptom of fearful apprehension. Scales do not, in other words, require the essential feature of a syndrome to be present. When a cutting-point is applied it divides cases from noncases in terms of an indiscriminate set of symptoms. A case can be identified based only on associated symptoms or only essential features.


Inadvertent instillation of an anesthetic into a blood vessel may cause seizures, jitteriness, or palpitations and may be avoided by always aspirating before infiltrating the local anesthetic. If a flash of blood is obtained on aspiration, pull the needle back partially, aspirate again, and instill only if no blood return occurs. Other reactions to local anesthesia are discomfort, bruising, and edema of the injection site. True anaphylaxis to lidocaine is estimated to occur in less than 1 of injections (Haugen and Brown, 2007). Administer diphenhydramine (Benadryl), 25 to 50 mg orally, intravenously, or intramuscularly in adults and 1 mg kg in children, and epinephrine 1 1000 subcutaneously every 5 minutes as needed. The adult dose of epinephrine 1 1000 is 0.3 to 0.5 mL kg and the pediatric dose 0.01 mL kg at the same intervals. Emergency response personnel should be notified, and prolonged observation may be warranted.

Panic Disorder

Panic disorder is diagnosed in children and adolescents who experience seemingly out-of-the-blue, overwhelming attacks of anxiety and are preoccupied with the fear of a recurring attack. Panic attacks occur unexpectedly even during sleep. A panic attack is defined as the abrupt onset of intense fear that reaches a peak within a few minutes and includes symptoms such as heart palpitations, shortness of breath or a smothering feeling, a fear of losing control or going crazy, and a fear of dying. These attacks usually are related to traumatic events and occur in the context of other anxiety disorders.

Buspirone to Paxil

Drugs are also available for managing the undesired peripheral physiological symptoms of anxiety. Palpitations and sweating can be reduced with 6-noradrenergic blockers (e.g., propranolol). Such beta-blockers effectively control the outward symptoms of anxiety such as those that commonly accompany public speaking and musical performances. Within the brain, it is also clear that 6-noradrenergic synapses promote the consolidation of fear memories (Cahill and McGaugh, 1998).

General Observations

Symptoms Some people with arrhythmias do not feel them others do. The same person may notice some arrhythmias and not others symptoms may vary and can include palpitations (feeling certain heart beats), skipped beats or fluttering sensations, fatigue, dizziness, lightheadedness, or even loss of consciousness. The factors accounting for this variability are complex and not always understood. The presence or absence of other cardiac medical problems may play a role in some cases. An abnormal ECG or irregular or unusually fast pulse may be the first clue of an arrhythmia. Some people have symptoms but when monitored have no arrhythmias.

EphedraMa Huang

The real story is that it increases both systolic and diastolic blood pressure as well as the heart rate, which causes palpitations, nervousness, headaches, insomnia, and dizziness. It can be harmful and life-threatening especially for those who suffer from heart conditions, hypertension, diabetes, and thyroid disease.

Signs and Symptoms

Into neurologic, cardiovascular, and gastrointestinal manifestations11 (Table 79-1). Neurologic symptoms are most frequent and range from apathy, dizziness, clouded senso-rium, and strange behavior to convulsions in very severe cases. In other instances, profound central nervous system depression occurs with coma and even death if left untreated. Cardiovascular signs and symptoms, such as palpitations, tachycardia, and chest pain, are less common and are primarily due to catecholamine release in response to low serum blood sugar levels. Gastrointestinal symptoms, such as hunger, nausea, and vomiting, may also occur in about 10 of patients, but by far the vast majority of symptoms are neurologic in nature. Many patients with insulinomas are obese because they find that they can prevent symptoms by eating more frequently.


Pheochromocytomas are responsible for 0.05 to 0.1 of all causes of hypertension and are rare during pregnancy with less than 200 cases reported in the literature (102,103). Although the most common symptoms in nonpregnant patients are hypertension, headaches, sweating, and palpitations, hypertension and headaches seem to predominate during pregnancy. While these tumors are rarely the cause of hypertension during pregnancy, if unrecognized or untreated they pose serious risks to both the mother and fetus. Maternal mortality rates have been reported in 17 to 48 and fetal demise in 26 to 54 of untreated cases (104-106). With early detection and treatment these mortality rates may be dramatically improved, with reported lows of 0 to 15 (105-107). Unfortunately, antenatal diagnosis is made in only 53 of cases (106).


Psychogenic seizures are episodes involving affective, autonomic, or sensorimotor manifestations that are precipitated by emotional distress. Palpitations, choking sensations, dizziness, malaise, acral paresthesias, sensory disturbances, crying, and alterations in consciousness with or without motor manifestations are observed. Unlike epileptic seizures, motor activity generally consists of side-to-side head movements, opisthotonus, pelvis thrusting, trembling, and random asynchronous movements. Micturition, injuries, amnesia, and postictal somnolence may occur. Psychogenic seizures tend to be less stereotyped, more gradual in evolution, and longer in duration than epileptic seizures.


Disulfiram has been available for the treatment of alcohol dependency since the late 1940s. Given as a single daily dose, disulfiram inhibits aldehyde dehydrogenase, the second alcohol degradation enzyme. This inhibition causes acetaldehyde to increase 5 to 10 times the usual level found after alcohol consumption. Symptoms that occur in patients acquiring alcohol from any source include flushing, palpitations, respiratory difficulty, nausea, vomiting, weakness, and general uneasiness. If alcohol consumption continues or a large volume is ingested, hypotension, syncope, loss of consciousness, and death may follow. Minor reactions may occur with inadvertent exposure from nonbeverage alcohol sources such as colognes, over-the-counter (OTC) medications, or foods with uncooked alcohol. Also used in attempted and completed suicides, disulfiram can be thought of as an incomplete poison that will become a complete poison if alcohol is added.

Chelating Agents

2,3,DimercaptoI (British antilewisite 'BAL') was synthesized during World War II as an antidote for arsenic-containing lewisite gas. This compound has also been found to be effective against the toxic manifestations of arsenic, mercury, gold, antimony, and other heavy metals. With doses of 2.5 mg kg of body weight, toxic symptoms develop in less than 1 percent of individuals with twice that dose, there is a 50 to 60 percent increase in the occurrence of intoxication. Symptoms appear within 10 to 20 minutes after injection of the drug and subside within 50 to 90 minutes. The usual reaction consists of headache, burning sensations in the mouth and eyes, muscular aches, paresthesias, pain in the teeth, lacrimation, salivation, rhinorrhea, and profuse sweating. Restlessness, anxiety, and general agitation may also develop, with progression in some instances to generalized convulsions and stupor. Abdominal pain, apprehension, blepharospasm, piloerection, tachycardia, and palpitations may...

Adrenal Disorders

The major clinical features of pheochromocytoma are headaches, palpitations, diaphoresis, hypertension, hypotension, pallor, weight loss, chest pain, and abdominal pain.yi Other features include dizziness, anxiety, nausea, vomiting, diarrhea, mydriasis, tachycardia, pulmonary edema, and CHF. y A more serious neurological feature is intracranial hemorrhage. Pheochromocytoma multisystem crisis is a serious and rare presentation that is characterized by encephalopathic features, multiple organ failure, fever, and labile blood pressure. 105 Pheochromocytoma can be associated with multiple endocrine neoplasia (MEN) type II, neurofibromatosis, and von Hippel-Lindau disease. y The differential diagnosis of hypertension associated with hyperadrenergic symptoms is extensive and includes thyrotoxicosis, anxiety and panic disorders, hypoglycemia, diencephalic epilepsy, acute myocardial infarction, abrupt clonidine withdrawal, and drug usage (e.g., monoamine oxidase inhibitors, cocaine,...

Etiology Percent

With non-neurological symptoms classically associated with pernicious anemia, including tiredness, syncope, palpitations, sore tongue, diarrhea, and other bowel disturbances. On examination, patients demonstrated a neuropathy alone (25 percent), isolated myelopathy (12 percent), and a combined neuropathy and myelopathy in 41 percent. Memory dysfunction and affective and behavioral changes were seen in 8 percent, whereas 14 percent had a normal examination.


Adverse effects of both long-and short-acting P2-agonists are dose-related and include palpitations, tachycardia, hypokalemia, and tremor. Sleep disturbance may also occur and appears to be worse with higher doses of inhaled long-acting P2-agonists. Increasing doses beyond those clinically recommended is without benefit and could be associated with increased adverse effects.

Hypoglycemic Crises

Although a popular diagnosis in the past for a variety of somatic complaints, from fatigue and depression to anxiety and palpitations, reactive (or idiopathic) hypoglycemia is, in fact, extremely uncommon.48 However, the use of the oral glucose tolerance test to diagnose this disorder is controversial. Marked hypoglycemia (glucose < 45 mg dL) occurring 2 to 5 hours after ingestion of a large glucose load (75 g) that reliably reproduces symptoms may be helpful. However, there is a great deal of variability in the response to this stimulus in normal individuals. Indeed, when symptomatic patients are tested rigorously, their symptoms often do not correlate with decreases in blood glucose.52 Thus, in many patients, no definitive therapy exists. Abnormalities in circulating levels of neuroactive compounds have been described in some patients with postprandial syndrome,53 although the significance of this remains unclear. When it is reliably diagnosed, true reactive hypoglycemia can be...

Mitral Stenosis

The main symptom of MS is slowly progressive dyspnea and fatigue. In advanced MS, left atrial pressure develops with a redistribution of blood to the chest. Patients might complain of orthopnea and paroxysmal nocturnal dyspnea. Pulmonary hypertension can become severe, and right-sided ventricular failure can then lead to dependent edema, hepatomegaly, and right upper quadrant pain. An increase in left atrial size can lead to palpitations secondary to atrial fibrillation, as well as subsequent cardioembolic strokes if not recognized in a timely manner.


' 'Was the fainting preceded by any other symptom nausea chest pain palpitations confusion numbness hunger '' The activity that preceded the syncope is important because some cardiac causes are associated with syncope during exercise (e.g., valvular aortic stenosis, idiopathic hypertrophic subaortic stenosis, and primary pulmonary hypertension). If a patient describes palpitations before the syncope, an arrhythmogenic cause may be present. Cardiac output may be reduced by arrhythmias or obstructive lesions.


Amiodarone-induced thyrotoxicosis is more common in men. Because amiodarone has -blocking activity, palpitations and tachycardia may be absent. In type 1 thyrotoxicosis, amiodarone should be discontinued. If amiodarone therapy cannot be stopped, larger doses of antithyroid drugs may be needed to control thyrotoxicosis. In type 2 thyroiditis, stopping amiodarone may not be necessary because spontaneous resolution may occur. Prednisone 40 to 60 mg day will quickly improve thyrotoxic symptoms. Prednisone may be tapered after 1 to 2 months of therapy.

QT prolongation

Prolongation of ventricular repolarization manifests as a prolongation of the QT interval on the electrocardiogram. QT prolongation may be associated with torsades de pointes tachycardia. Torsades de pointes are often self-limited and are associated with palpitations, dizziness or syncope. Degeneration into ventricular fibrillation and sudden cardiac death can occur. In addition to the congenital long QT syndrome many drugs, such as antiarrhythmic drugs class IA and III, antibiotics, antihistamines, neuroleptics and anti-depressants, are known to prolong the QT interval. Information about QT-prolonging drugs can be obtained from the internet ( Most of these drugs block a specific potassium channel substantially involved in ventricular repolarization. Cardiovascular diseases induce a higher susceptibility to drug-induced prolongation of the QT interval. Correctable factors include hypokalemia, concomitant administration of different QT-prolonging drugs and...


Nifedipine is a dihydropyridine derivative which is a systemic and coronary arterial vasodilator. It is effective in countering coronary artery spasm, thought to be an important component of all forms of angina, and it may bring symptomatic relief in patients with peripheral vasospastic (e.g. Raynaud's) disease. Its anti-anginal effect is additive with that of p-adrenergic blocking drugs and nitrates. Adverse effects related to the vasodilating action of nifedipine include flushing, headaches, ankle oedema, dizziness, tiredness and palpitations. Nifedipine is absorbed rapidly, particularly when the stomach is empty, with an onset of action of 20 min. This may produce reflex tachycardia and increased myocardial contractility, although nifedipine is cardiopressant in vitro. It is well absorbed (> 90 ), but undergoes significant hepatic firstpass metabolism. It is metabolized in the liver to inactive metabolites and is excreted mainly via the kidneys with an elimination


As terazosin was associated with an increase in cardiovascular events. aiBlockers may be considered as add-on therapy to other agents (i.e., 3rd or 4th line) when hypertension is not adequately controlled. In addition, they may have a specific role in the antihypertensive regimen for elderly males with prostatism however, their use is often curtailed by complaints of syncope, dizziness, or palpitations following the first dose and orthostatic hypotension with chronic use. The roles of doxazosin, terazosin, and prazosin in the management of patients with hypertension are limited due to the paucity of outcome data and the absence of a unique role for special populations or compelling indications from JNC 7.

Heart Disease

Examination of the pulse played an important role in diagnosis and prognosis in Hindu medicine. But the nature of circulation and cardiac function was not well understood, which helps to explain the sketchy nature of the descriptions of cardiac diseases in the texts. Moreover, the descriptions in the Sushruta and the Caraka do not exactly correspond. Heart disease due to disturbed Vayu that caused palpitations, pain, slowing of the heart rate, fainting fits, and murmuring sounds in the heart constitutes the only condition that truly suggests a cardiac disorder. Other diseases of the heart seem more like gastrointestinal disorders in that they could be caused by bad eating habits, and their symptoms included a sense of heaviness in the precordium, a bitter or acid taste in the mouth, tiredness, and belching. Another type of heart disease was due to parasites arising in putrefied food. Here, the parasites were thought to invade one portion of the heart and gradually destroy the rest.


Specific irregularities in the contents and movements of each of 11 such vessels revealed specific illnesses. The Huang-ti nei-ching, however, described 12 vessels, or conduits, which were interconnected. This text advocated the feeling of pulses at various locations of the body to examine movement in the individual sections of the vessel circuit and to diagnose the condition of the functional units associated with these sections. Finally, the Nan-ching proposed the feeling of the pulses at the wrists only and developed complicated methods for extracting detailed information on the origin, present location, and possible future courses of an illness. In addition, the Huang-ti nei-ching and the Nan-ching provided ample data on the meaning of changing colors in a person's complexion, of changes in a person's voice or mouth odor, and of changes in longing for a specific flavor. Furthermore, the Nan-ching recommended investigations of the condition of the skin of the lower arms...

Timing And Frequency

For those athletes older than the age of 35, the American Heart Association recommends exercise testing in men older than 40 years of age and women older than 50 who have one or more cardiac risk factors and or symptoms of chest pain, palpitations, or syncope. Athletes who are 65 years or older and athletes with a history of coronary artery disease with or without symptoms should have an exercise stress test regardless of risk factors.8 When athletes are not allowed to participate in their sport, recommendations should be made for activity that is appropriate.


Athletes with this disorder usually are diagnosed during adolescence or young adulthood. They may present with palpitations, shortness of breath, or dyspnea on exertion. The physical examination may be unremarkable. ECG will usually demonstrate depolarization and repolarization changes localized to the right precordial leads, and echocardiography may reveal right ventricular dilation with global and or regional wall motion abnormalities. Continuous electrocardiographic monitoring can reveal arrhythmias of right ventricular origin. Magnetic resonance imaging may be useful in demonstrating telltale fibrofatty infiltration and structural alteration of the right ventricle.


Have an AV nodal re-entry tachycardia or an atrioven-tricular re-entry tachycardia utilizing an accessory pathway with or without pre-excitation in the resting ECG. More rarely ectopic atrial tachycardias are found. The tachycardia often starts during exercise when catecholamine levels increase. Patients may feel shortness of breath, palpitations, dizziness and in some cases also syncope. These arrhythmias are generally considered relatively benign but depending on the situation the abrupt onset can make them dangerous, e.g. during diving, cycling, driving etc. In older subjects they may also give more serious symptoms. Individuals with a history of tachycardias with sudden onset especially with symptoms such as dizziness or syncope should be investigated for a diagnosis. Today the arrhythmia can in most cases be cured by radiofre-quency ablation. Of note is that resting ECG in most cases is totally normal. Subjects with overt pre-excitation in their ECG can sometimes have an...