Palpitation
Palpitation [3] is the awareness of heartbeat and occurs commonly during exertions and heightened emotions. It could also be caused by an abnormal cardiac rhythm. Rapid and irregular palpitations are indicative of atrial fibrillation. They can be seen as missed heartbeats or forceful beats.
PAH due to prolonged pressure and volume overload can cause remodeling of the right atrium and the left atrium which leads to palpitation in patients. Factors leading to this remodeling include; autonomic activity modulation, delayed cardiac repolarization and right ventricular myocardial ischemia.
It has been discovered that an increase in pulmonary pressure that causes a reduction in cardiac output provokes a change in autonomic activity leading to an increase in sympathetic drive and resultant arrhythmic effect.
Diuretics are used in the treatment of pulmonary hypertension, they are known to cause severe electrolyte abnormalities which happens in the background of an altered cardiac repolarization.