Womack Army Medical Center, Fort Liberty, N.C.
Am Fam Physician. 2024 Sep;110(3):259-269.
Palpitations are a common symptom described by patients as a feeling of a racing or fluttering heart, a pounding chest, irregular or skipped heartbeats, or a pounding sensation in the neck. They are associated with a low mortality rate; however, recurrent palpitations have been shown to impair quality of life and increase health care use. Common triggers are cardiac disorders, endocrine and metabolic disorders, medication or illicit drug use, or psychosomatic disorders. A detailed history, physical examination, directed laboratory studies, and 12-lead electrocardiography are often sufficient to identify the etiology of palpitations. Additional testing may be indicated to include echocardiography, cardiac stress testing, electrocardiogram monitoring, or electrophysiologic studies to distinguish whether symptoms correlate with cardiac arrhythmia or structural or ischemic heart disease. Management of palpitations is based on the suspected etiology. In most cases of cardiac-induced palpitations, the treatment can include reassurance, education, trigger avoidance, or use of atrioventricular nodal blockers. Tachyarrhythmias may require cardiac ablation. Patients who have palpitations with no arrhythmia causality and no cardiac disease should be reassured; however, screening for psychosomatic disorders should be considered. Wearable smart devices with ambulatory electrocardiogram monitoring technologies are currently available to consumers; these tools have shown diagnostic accuracy for detection of arrhythmias, allowing patients to have greater participation in their health care. Am Fam Physician. 2024; 110(3):259-269.
心悸是患者常描述的一种症状，表现为心跳加速或颤动、胸口怦怦跳、心跳不规则或漏跳、颈部有重击感。尽管心悸的死亡率较低，但反复发作的心悸已被证明会降低生活质量并增加医疗保健的使用。常见的诱因有心律失常、内分泌和代谢紊乱、药物或非法药物使用或心身障碍。详细的病史、体格检查、有针对性的实验室研究和 12 导联心电图通常足以确定心悸的病因。可能需要进行额外的检查，包括超声心动图、心脏应激测试、心电图监测或电生理研究，以区分症状是否与心律失常或结构性或缺血性心脏病有关。心悸的管理基于疑似病因。在大多数由心脏引起的心悸病例中，治疗可以包括安慰、教育、避免诱因或使用房室结阻滞剂。心动过速可能需要心脏消融。对于无心律失常原因且无心脏疾病的心悸患者，应予以安慰；然而，应考虑筛查心身障碍。具有动态心电图监测技术的可穿戴智能设备目前可供消费者使用；这些工具对心律失常的检测具有较高的准确性，使患者能够更积极地参与自身的医疗保健。美国家庭医师学会。2024；110（3）：259-269。
