HEARTBEAT (palpitatio cordis) — feeling speeded up, strengthened or misoperation of own heart.
Heartbeat most often meets at the organic lesions of heart which are followed by tachycardia or arrhythmia (myocardites, heart diseases, a cardiosclerosis the phenomena of a circulatory unefficiency, thyrocardiac heart, a pulmonary heart), at functional and organic lesions of a nervous system, vegeto-vascular dystonia, and also at astenizirovanny persons after the postponed acute infection. It can be observed at diseases of digestive tract, at a pheochromocytoma and others patol. states. The healthy person feels S. only at a considerable exercise stress, extraordinary psychoemotional tension (a sudden strong fright), at situation on spin, the left side. In these cases of S. happens short and is not followed by unpleasant feelings. Only in extreme situations (e.g., at a considerable exercise stress in the conditions of highlands) S. at healthy people can be burdensome. At almost healthy faces even expressed tachycardia (see) S. (e.g., tachycardia is not always followed at high temperature). At various patol. S.'s conditions can be considerable.
As heart is deprived of tangoreceptors, its activity causes subjective (very individual) reaction indirectly, owing to concussion of structures, adjacent to it. Quite often the patient does not complain of S. even at the heart rate exceeding 120 — 130 blows in 1 min. But persons, at to-rykh even insignificant increase of cordial reductions meet (e.g., to 90 blows in 1 min.) is followed
by S. S. feeling arises not only at tachycardia; sometimes it appears at normal rate of cordial reductions, and is frequent also at bradycardia. In this case S. is, as a rule, connected with a hyperkinesia of heart since according to Frank's law — Starlinga (see. Starlinga law ) force of reduction of heart is especially big after a long diastole, i.e. at bradycardia. Normal tekhmp cordial reductions and lack of symptoms of a hyperkinesia of heart is pointed often to a psychogenic origin of Page.
At complaints to S. for clarification of the reason of its emergence it is necessary to define character of Page. Constant S. meets at the heart diseases which are followed by tachycardia, a tachyarrhythmia or at a pulmonary heart more often (see. Pulmonary heart ), and also at expressed thyrotoxicosis (see) and an alcoholism (see. alcoholism ). Sometimes long S. is observed at mental diseases.
At pristupoobrazny character of S. communication with an exercise stress indicates it existence at the patient cordial or a pulmonary heart. Pristupoobrazny character of S. is noted also at astenizirovanny persons after transferred them inf. diseases. Apparently, in this case, as well as at nek-ry intoxications, the latent heart failure connected with matters myocardial dystrophy (see). The heartbeat which is observed upon transition of the patient from horizontal position in vertical is most characteristic of the states connected with disturbance of a vascular tone. It is observed, e.g., at Shai's disease — Dreydzhera (see. Shai — Dreydzhera a syndrome ), at a drunkenness, and also owing to effect of many medicines (hypotensive, derivative a fenotiazina, etc.). Nek-ry pharmaceuticals (m-holino-lytic, sympathomimetic, etc.) can cause passing S. too (it is not connected in these cases with change of position of the patient).
The page after meal can be manifestation gastrocardial syndrome (see). The page connected with insignificant psychoemotional tension or which is periodically arising without the visible reasons can be caused by disturbance of the central mechanisms of regulation of cardiovascular system (vegeto-vascular dystonia). However with externally causeless S.'s attacks it is necessary to find out from patients whether there is S.'s attack suddenly or gradually, and also whether S. or slowly stops at once. In the first case it is necessary to think about Bouveret's disease (see) or ciliary arrhythmia (see), in the second — about the attacks of sinus tachycardia most often caused by psychogenic factors or other noncardiac pathology (a hyperthyroidism, a pheochromocytoma). The village upon transition of the patient from vertical position in horizontal, as a rule, is caused premature ventricular contraction (see).
For statement of the correct diagnosis force, speed and a rhythm of the reductions of heart felt by the patient has a certain value. So, despite often subjective perception of a rhythm and rate of cordial reductions (nek-ry patients do not feel attacks of a ciliary tachyarrhythmia), complaints to chaotic S. allow to think of a ciliary arrhythmia, and complaints to rare and strong reductions of heart — of the allorhythmic premature ventricular contraction or bradycardia connected with disturbances of endocardiac conductivity (see. Heart block ).
The factors stopping an attack S. Tak, stopping of an attack by means of certain maneuvers have important diagnostic value (a natuzhivaniye, artificial provocation of gaggings, etc.) almost always speaks about a supraventricular Bouveret's disease, the accurate termination of attacks under the influence of antiarrhythmic means allows to think of a Bouveret's disease or a ciliary arrhythmia, the effect of reception of tranquilizers, Corvalol or valocordin indicates neurogenic sinus tachycardia.
Anamnestic data and a medical research not always allow to make the diagnosis, especially if S. has pristupoobrazny character. An important role is played by the electrocardiographic research at the time of an attack allowing to reject subjective character of S. and to establish its source. In not clear cases it is reasonable to inspect patients in kardiol. clinic or hospital.
S.'s therapy is defined by the pathology which caused it. In the absence of organic lesions from cardiovascular system purpose of sedatives, tranquilizers, psychotherapy is reasonable. The village arising against the background of reception of medicines demands reduction of a dose or cancellation of drugs. At suspicion on S.'s communication with noncardiac pathology consultation of the psychiatrist, endocrinologist, etc. is necessary.
V. A. Bogoslovsky.