However, testing may be necessary to differentiate it from angina pectoris. Anxiety, the hyperventilation syndrome, or both are often associated with chest pain that may mimic angina pectoris, though the pain caused by anxiety or hyperventilation is usually sharp and fleeting or very prolonged and highly localized. Patients report a sensation of skipping, fluttering, pounding, or racing. It is useful to have the patient describe the regularity or irregularity and the approximate rate of the palpitation. Associated light-headedness or syncope should be ascertained.
Sinus tachycardia is more gradual in onset and termination.
Patients may not sense palpitation during ventricular tachycardia. Rather, they may experience dyspnea, syncope, or severe fatigue. The palpitations sensed during anxiety states may be caused by the patient's heightened awareness of cardiac activity. Normal sinus rhythm or sinus tachycardia is usually present. Historical points that favor a cardiac origin for syncope include sudden onset without warning, sensation of rapid heart action before loss of consciousness, and lack of an aura or seizure activity, although the last of the three may occur during dysrhythmias as a result of decreased cerebral perfusion.