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Awareness of Adult Population Toward Palpitation and Its Risk Factors In Fehaid Alanazi et al, 2020;4(2):383–388. International Journal of Medicine in Developing Countries https://doi.org/10.24911/IJMDC.51-1575930917 ORIGINAL ARTICLE Awareness of adult population toward palpitation and its risk factors in Riyadh region, Saudi Arabia Fehaid Alanazi1, Khalid Ayidh Alotaibi2*, Fehaid Saleh Almutlaq2, Ahmed Abdulrahman Aldahash2, Abdulaziz Ibrahim Alsenani2 ABSTRACT Background: Palpitations are a sensory symptom and are often described as a skipped beat, rapid fluttering in the chest, pounding sensation in the chest or neck, or a flip-flopping in the chest. Palpitations are nonspecific and can be a symptom or a diagnosis. This study aims to measure the level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia. Methodology: The cross-sectional study, distributed among the adult population who were both male and female in Riyadh region, Saudi Arabia. Data were collected by pre-tested questionnaire and analyzed by using Statistical Package for the Social Sciences version 22 to assess the level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia. Results: The study included 331 respondents; about 31.1% of them were within the age range of 18–30, 11.5% were less than 18 years, and 93.1% were from Saudi Arabia, while 6.6% were Non-Saudis. For the general awareness, out of 331 respondents, only 70 participants who had experienced any heart palpitations were taking medications. Also, the Chi-Squared test also confirms that there is a significant relationship between medication used and experiencing Palpitations. Conclusion: Palpitations due to cardiac origin could be because of any reason, including arrhythmias, valvular heart diseases, cardiomyopathy, and pacemakers. The second most common cause is of psychiatric origins, such as a panic attack, anxiety, depression, and somatization. Overall, there is a need for an increased level of awareness of adult population toward palpitation and its risk factors in Riyadh Region, Saudi Arabia. Keywords: Palpitation, awareness, cardiovascular diseases, Riyadh, Saudi Arabia. Introduction Palpitation is one of the most common presenting toward palpitations and side effects of energy drinks symptoms to outpatient cardiologist/internists’ clinics, consumption [4]. Palpitation has a wide extensive which represents 16 percent out of 500 medical differential diagnosis in a study conducted among 190 outpatients [1]. Palpitation is defined as a rapid pulsation, patients presented to the clinic with chief complain of an abnormally rapid or irregular beating of the heart. palpitations. It showed that among the 190 patients, Palpitations are a sensory symptom and are often in 84% the cause was determined, the most common described as a skipped beat, rapid fluttering in the chest, cause was cardiac origin (43%), and 31 present were pounding sensation in the chest or neck, or a flip-flopping in the chest. Palpitations are nonspecific and can be a symptom or a diagnosis [2]. Correspondence to: Khalid Ayidh Alotaibi Regarding the prevalence of heart palpitations in Saudi *Medical Intern, Majmaah University, Al Majmaah city, Arabia, 20% participants, out of 257 medical students Saudi Arabia. Email: [email protected] at Umm Al-Qura University in 2013, experienced Full list of author information is available at the end of palpitations as a side effect of energy drinks consumption the article. [3]. Goyal et al [4] recommended for more awareness Received: 09 December 2019 | Accepted: 26 December 2019 companies and clubs to increase the awareness © IJMDC. https://www.ijmdc.com 383 Awareness of population toward palpitation due to psychiatric causes, miscellaneous causes (e.g., record 24–48 hours to assess any cardiac abnormalities medication-induced, thyrotoxicosis, caffeine, cocaine, during the day [8]. Patients who experience palpitations anemia, amphetamine, mastocytosis) were only 10% with exertion should be evaluated with standard exercise [5,6]. Another study was conducted in 2003, among 184 stress testing because they are at higher risk of morbidity participants who complained of palpitations in the out- and mortality. An electro-physiologic study may be patient cardiac clinic, it showed 34% had arrhythmia, warranted in patients with palpitations preceded by and 41% had extrasystoles and also showed awareness of syncope or near-syncope, as well as in those in whom sinus rhythm in 26% [7]. there is a high index of suspicion of a cardiac origin not In their study, they (Nymes, Mathiesen, Njolstad, diagnosed with other studies. ECG helps to evaluate Wilsgaard, & Lochen, 2012) examined the effects the patients for structural heart disease and should be of palpitations and cardiovascular risk factors in the performed when initial history and physical examination prediction of atrial fibrillation (AF). The study involved are unrevealing, or in patients with a history of cardiac a massive population-based cohort design and samples disease or more complex signs and symptoms (e.g., of 22,815 study participants were involved. For data dyspnea, orthopnea, and lower extremity edema) [9]. analysis purposes, the researchers used a regression The management of palpitations is determined by the model to generate Cox proportional hazards that played underlying cause of the symptoms [10]. Radiofrequency a significant role in the estimation of hazard ratios for ablation can cure most types of supraventricular and AF. The results showed that women have high chances of many types of ventricular tachycardia [10]. The most getting AF compared to men. Besides, it was evident that challenging cases involve palpitations that are secondary body mass index and height have high risks on AF in men. to supraventricular or ventricular ectopy or associated The study concluded that palpitations, body mass index, with normal sinus rhythm. These conditions are thought and hypertension leads to AF in both men and women. to be benign, and the management involves reassurance of Palpitations due to cardiac origin could be because the patient that these arrhythmias are not life threatening. of any reason, including arrhythmias, valvular heart In these situations, when the symptoms are unbearable or diseases, cardiomyopathy, and pacemakers. The second incapacitating, treatment with beta-blocking medications most common cause is of psychiatric origins, such as could be considered and may provide a protective effect a panic attack, anxiety, depression, and somatization. for otherwise healthy individuals [11]. Also, other causes can cause palpitations like The management of most sustained supraventricular or medications (Sympathomimetics agents, vasodilators, ventricular arrhythmias causing palpitations involves anticholinergics, and beta-blockers withdrawal), cocaine, referral to a specialist trained in the pharmacologic and amphetamines, caffeine consumption, and nicotine. invasive electrophysiologic management of arrhythmias. Metabolic disorders can cause palpitations, such as Most types of regular supraventricular tachycardias and hypoglycemia, thyrotoxicosis, and pheochromocytoma. some types of ventricular tachycardias are now curable Anemia, pregnancy, fever, stress, and exercise are the with radiofrequency ablation [12]. Patients who present causes of palpitations [5,6]. to the emergency department who are asymptomatic, with To determine the cause of the palpitations, a careful unremarkable physical examinations, non-diagnostic history and physical examination should be done. Patients ECGs and normal laboratory values, can safely be sent may describe palpitations in a variety of ways, such as home and instructed to follow up with their primary care a fluttering, pounding, or uncomfortable sensation in provider or cardiologist. Patients whose palpitations the chest or neck, or simply an increased awareness of are associated with syncope, uncontrolled arrhythmias, the heartbeat. History should include age to narrow the hemodynamic compromise, or angina should be admitted differential diagnosis, socio-demographic data, stressors for further evaluation [2]. and psychiatric illness screening, drug and energy drinks The results of this study would enable the healthcare should be screened also [8]. sector to develop effective policies and reforms that Physical examination primarily serves to determine would address palpitation and its risk factors, both in the if there are cardiac or other abnormalities present present and in the future. Using the results of this study, that might predispose the patient to palpitations. The scholars would be able to conduct further research and physician should look for evidence of hyperthyroidism address the existing gaps identified in the research. (e.g., nervousness, heat intolerance), drug use, or other Subjects and Methods serious illnesses. Finally, in the occasional patient who has palpitations with exercise, the examination of the This study adopted a cross-sectional design, conducted patient after he or she exercises may reveal an arrhythmia in Riyadh region, Saudi Arabia, 2019. Riyadh is located or murmur that is exacerbated by the resulting increased at the center of Saudi Arabia and it occupies an area heart rate and cardiac output. 12-lead Echocardiography of 404,240 kilometers per square and has a population (ECG) should be done to the patient who complains of of approximately 8.2 million people. Riyadh region is palpitations, to exclude cardiac causes. Complete blood
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