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What is the cause of palpitations and swollen neck ?

My wife had heart palipations earlier this morning. She was in the hospital for them earlier this month and initially diagnosed with a viral infection of the heart. Since then, she went back into the emergency room with bad heart palipitations, had an EP test, and now they think it may be something else. They have referred her to a specialist but we can t get in until May 31st. They also told her that if the palipations resume, to bear down, cough , or rub her karotid artery . This morning she rubbed her karotid artery on the left side of her neck. Now her neck is swollen on the left side and she is still experiencing discomfort. Any advice?
Asked On : Wed, 11 Apr 2012
Answers:  4 Views:  694
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General & Family Physician 's  Response
Thanks for writing in.
Your wife probably has an arrhythmia which is originating above the AV node. This node connects the atria above and the ventricles below ( 2 chambers of the heart). Typically, an electrical impulse will travel from the atria to the ventricles through the AV node.
There are several ways in which the heart rate can be controlled in this condition. These are known as vagal maneuvers and would help control the symptoms. There are several maneuvers and any one of them can be employed to control the heart rate:
a. Valsalva's maneuver: She needs to inhale and hold her breath and:
- Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds.
- Blow forcefully through a straw for as long as possible (at least 20 seconds)
This needs to be done only till the heart rate gets controlled. DO NOT DO THIS EXCESSIVELY. IT CAN LEAD TO A VERY LOW HEART RATE AND FAINTING
b. Carotid sinus massage: The technique which needs to be followed is :
Apply gentle and steady pressure over the right carotid sinus and hold for 5-10 seconds.
Gentle and steadily massage motion over the right carotid sinus for 5-10 seconds. DO NOT DO THIS EXCESSIVELY. IT CAN LEAD TO A VERY LOW HEART RATE AND FAINTING

The exact cause needs to be identified for proper treatment to be instituted.
Hope this helps.
Answered: Wed, 11 Apr 2012
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General & Family Physician Dr. Jeevan Jyot Bahia's  Response
Palpitations are experienced by patients when the develop tachycardia. During palpitations do measure her heart rate by palpating radial is very simple just keep tip of index and middle finger over inner side of your wrist and you can feel it. If her heart rate is above 150 beats per minute do consider it might be Paroxysmal supraventricular tachycardia. Valsalva maneuver, pressure over orbits or apply pressure over the carotid artery also called Carotid massage are all done ti abet it.
I think you have done vigorous massage and probably that is the reason her neck is swollen.
Also do get her investigated for Thyroid function test, Echocardiography to rule any structural valvular abnormality, 24 hour ambulatory holter monitoring to ascertain the rhythm and rate of her heart.
Answered: Wed, 11 Apr 2012
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Oncologist Dr. Jawahar Ticku's  Response
It will not be a good idea to suggest the measures unless you have establlished the cause. the arrythmias can occur because of a seprate focus in the heart which functions as an independent pacemaker and seprate pace maker beats are superimposed on each other to give feeling of palpitation. Vagal stimulation or valsalvas manure are futile in this condition. Yes they are useful in atrial flutter. but It is again necessary to identify the cause for which at leat basic ECG is needed. you must note that hypperthyroidism is another imp. cause but it can be investigated after the ECG .
Answered: Wed, 11 Apr 2012
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Oncologist Dr. Jawahar Ticku's  Response
Heart palpitation has many of the main causes is anaemia I.e is reduced heamoglobin. You need complete gen. Physical examination, complete blood count and an ECG with long lead 2 to determine the cause of palpitation. After going through these basic things the palpitation can completely be cured. Visit your basic physician to establish the cause.
Answered: Wed, 11 Apr 2012
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