CLINICAL SYMPTOMS OF

ARRHYTHMIAS
A k h t a r F a j a r M u z a k k i r, M D , F I H A

M A K A S S A R C A R D I O VA S C U L A R
U P D AT E X I V 2 0 1 5
 INTRODUCTION
• An arrhythmia is any rhythm that is not normal sinus rhythm with
normal atrioventricular (AV) conduction

• Clinicians in many disciplines commonly face the problem of

evaluating and treating patients with cardiac arrhythmias

• Randomized trials, technological advances, and better understanding

of arrhythmia mechanisms have resulted in improved approaches to
rhythm disturbances

Basic evaluation and management principles are key to

the initial approach to the patient with an arrhythmia
INTRODUCTION
Basic evaluation and management principles are key to
the initial approach to the patient with an arrhythmia

3 reasons to evaluate and treat arrhythmias

Eliminate symptoms

Prevent imminent death and

hemodynamic collapse due to a
life-threatening arrhythmia

Reduce possible risks other than the

direct effects of the arrhythmia (eg,
reduce stroke in pts with AF)
TYPE OF ARRYHTHMIAS

Ventricular
Ventricular
Atrial
Supraventricular
Atrial
Atrioventricular
Sinus
Ventricular
COMMON
Tachycardia
Premature
Fibrillation
Tachycardia
Bradycardia
(AV) Block
Fibrillation
(VT)
Beats (APBs)
(VPBs)
(AFib)
(SVT)
ARRHYTHMIAS 
(VF)
TYPE OF ARRYHTHMIAS
Supraventricular
Ventricular Tachycardia Atrial
Premature (SVT) Fibrillation
Beats (VPBs) (AFib)

Atrial Ventricular
Premature
COMMON
Tachycardia
Beats (APBs) ARRHYTHMIAS  (VT)

Ventricular
Atrioventricular
Fibrillation
(AV) Block
Sinus (VF)
Bradycardia
CLINICAL MANIFESTATION
Palpitation

Dizziness
Tinnitus
Lightheadedness
Visual Changes
Syncope/Near Syncope
Increased Urinary Frequency
Chest Discomfort
Abdominal Discomfort
Neck Discomfort
Peripheral Edema
Dyspnea

Weakness

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION
Palpitation

Dizziness Ventricular Tachycardia (VT)

Ventricular Fibrillation (VF)

Lightheadedness
Supraventricular Tachycardia (SVT)
Syncope/Near Syncope
Atrial Fibrillation (AFib)
Chest Discomfort
Ventricular Premature Beats (VPBs)
Neck Discomfort
Atrial Premature Beats (APBs)
Dyspnea Atrioventricular (AV) Block

Weakness Sinus Bradycardia

Anxiety
CLINICAL MANIFESTATION

Palpitation

Principal goal in assessing patients with

palpitations is to determine if the symptom
is caused by a life threatening arrhythmia
CLINICAL MANIFESTATION
Palpitation

HOW TO EVALUATE PALPITATIONS ?

STEP 1
Is palpitation continuous or intermittent ?
Intermittent palpitation are commonly caused by premature atrial or
ventricular contractions

STEP 2
Is heart beat regular or irregular ?
Regular and sustained palpitations can be caused by SVT and VT
Irregular and sustained palpitations can be caused by Atrial fibrillation

STEP 3
What is the heart rate ?
CLINICAL MANIFESTATION
Palpitation

HOW TO EVALUATE PALPITATIONS ?

STEP 4
Does palpitations occur in discrete attacks ? Is onset abrupt ?
How do attacks terminate ?
Ventricular arrhythmias are of sudden onset.
Holding breath, coughing, or vagal manoeuvres decrease palpitations
in SVT
STEP 5
Are there any associated symptoms ?
Chest pain (arrhythmogenic MI); dyspnea (heart failure due to
arrhythmias); syncope (low cardiac output during arrhythmias,
hypoglycemia, phaechromocytoma); polyuria (SVT); sweating (anxiety,
hypoglycemia); diarrhoea (thyrotoxicosis)
CLINICAL MANIFESTATION
Palpitation

HOW TO EVALUATE PALPITATIONS ?

STEP 6
Are there any precipitating factors ?
Exercise, stress (hyperdynamic cardiovascular states caused by
catecholaminergic stimulation), alcohol intake, drugs

STEP 7
Is there a history of structural heart disease ?
Coronary heart disease, valvular heart disease
CLINICAL MANIFESTATION
Nature of Palpitation

FEATURE SUGGESTS

HEART MISSES AND THUMPS ECTOPIC BEATS

ECTOPIC BEATS
WORSE AT REST

VERY FAST REGULAR SVT / VT

SUDDEN ONSET SVT / VT

OFFSET WITH VAGAL MANOEUVRES SVT

FAST AND IRREGULAR AF and ATRIAL FLUTTER with varying block

AWARENESS OF SINUS RHYTHM

FORCEFUL AND REGULAR – NOT FAST
(ANXIETY)

SEVERE DIZZINESS OR SYNCOPE VT or BRADYARRHYTHMIAS

PRE-EXISTING HEART FAILURE VT

CLINICAL MANIFESTATION
Simple Approach to Diagnose Palpitation

Is heart beat
regular ?

YES NO
Are there any discrete attacks of Irregular heart
tachycardia >120/min beat

NO Ectopic beats
YES
Sinus tachycardia AF
SVT or VT
High stroke volume
TAKE HOME MESSAGES
• Symptom type and severity are related to :
✓ the etiology and rate of the arrhythmia
✓ the nature and severity of underlying heart disease
✓ the patient itself

• The symptom severity often dictates the urgency for therapy

or even the need to evaluate and treat

• The presence of structural heart disease is a key issue that

determines the urgency of intervention, evaluation, therapy,
and the prognostic importance of the arrhythmia
 optimist I’m in love

??

HEART PALPITATION

pessimist I’m dying

THANK YOU