Editing Palpitations (section)

==Pathophysiology==

The sensation of palpitations can arise from extra-[[systole]]s or [[tachyarrhythmia]].<ref name="Robinson Sanchack 2019"/> It is very rarely noted due to [[bradycardia]].<ref name="Robinson Sanchack 2019"/> Palpitations can be described in many ways.<ref name="Robinson Sanchack 2019"/> The most common descriptions include a flip-flopping in the chest, a rapid fluttering in the chest, or pounding in the neck.<ref name="Robinson Sanchack 2019"/> The description of the symptoms may provide a clue regarding the etiology of the palpitations, and the pathophysiology of each of these descriptions is thought to be different.<ref name="Robinson Sanchack 2019"/>  In patients who describe the palpitations as a brief flip-flopping in the chest, the palpitations are thought to be caused by extra- systoles such as [[supraventricular arrhythmia|supraventricular]] or [[ventricular arrhythmia|ventricular]] [[arrhythmia|premature contraction]]s.<ref name="Robinson Sanchack 2019"/> The flip-flop sensation is thought to result from the ''forceful'' contraction following the pause, and the sensation that the heart is stopped results from the pause.<ref name="Robinson Sanchack 2019"/> The sensation of rapid fluttering in the chest is thought to result from a sustained [[ventricular arrhythmia|ventricular]] or [[supraventricular arrhythmia]].<ref name="Robinson Sanchack 2019"/> Furthermore, the sudden cessation of this arrhythmia can suggest [[paroxysmal supraventricular tachycardia]].<ref name="Robinson Sanchack 2019"/>  This is further supported if the patient can stop the palpitations by using [[Valsalva maneuver]]s.<ref name="Robinson Sanchack 2019"/> The rhythm of the palpitations may indicate the etiology of the palpitations (irregular palpitations indicate [[atrial fibrillation]] as a source of the palpitations).<ref name="Robinson Sanchack 2019"/> An irregular pounding sensation in the neck can be caused by the dissociation of [[mitral valve]] and [[tricuspid valve]], and the subsequent [[Atrium (heart)|atria]] are contracting against a closed [[tricuspid]] and mitral valves, thereby producing [[cannon A waves]].<ref name="Robinson Sanchack 2019"/> Palpitations induced by [[exercise]] could be suggestive of [[cardiomyopathy]], [[ischemia]] or [[channelopathies]].<ref name="Robinson Sanchack 2019"/>