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Investigating Selected Symptoms |

Palpitations, Arrhythmias, and Awareness of Cardiac Activity

Arthur J. Barsky, MD
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From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Grant Support: By research grant MH 40487 from the National Institute of Mental Health and grant HL 43216 from the National Heart, Lung, and Blood Institute.

Requests for Single Reprints: Arthur J. Barsky, MD, Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Ann Intern Med. 2001;134(9_Part_2):832-837. doi:10.7326/0003-4819-134-9_Part_2-200105011-00006
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Somatic and visceral symptoms have a surprisingly weak relationship to objective measures of tissue pathology. This is exemplified by the poor correlation found between palpitations and cardiac arrhythmias. Many factors other than extent of disease influence symptomatic distress, and since symptoms are such a crucial feature of illness and of medical practice, much more investigation of these nonbiomedical influences is needed. Although experimental laboratory paradigms facilitate such investigation, there are problems involved in generalizing from laboratory findings to the reporting of the symptoms of disease in daily life. In studying the awareness of cardiac arrhythmias and of resting heartbeat, we have found that the palpitations of patients who somatize more and have more health-related anxiety and more psychiatric distress are significantly less likely to be related to demonstrable cardiac arrhythmias than are the palpitations of other patients. The accurate awareness of arrhythmias, however, is not associated with the accurate awareness of resting heartbeat. Even more surprising, a relatively large proportion of heart transplant recipients are accurately aware of their resting heartbeat. This work poses more questions than it answers. In so doing, it underscores some of the technical difficulties of conducting research in this area and shows how little is known about symptom perception, processing, and reporting.





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