The hyperkinetic heart syndrome is an idiopathic cardiac condition that involves heart overactivity and hypercontractility, augmented cardiac output and elevated pulse pressure, without an underlying cardiac pathology [1] [2].

It is primarily diagnosed in patients aged 7-48 years and patients are mostly asymptomatic and in good health [3] [4]. Exercise tolerance is normal, and, due to the absence of symptoms, patients are usually referred for a cardiological evaluation for an auscultated heart murmur. The hyperkinetic heart symptom was first described by R. Gorlin in 1959.

A minority of the patients may report palpitations or fatigue, due to co-existing conditions, such as mitral stenosis or congestive cardiomyopathy [4].

• Heart Disease

  Thus, ischemic heart disease, valvular heart disease, arrhythmias, and conduction defects have been assigned a high priority reflected by their location in the first few sections of this book. [books.google.de]

  […] medical term "coronary heart disease" is presented. [connection.ebscohost.com]

  The hyperkinetic heart syndrome also referred to as hyperkinetic heart disease or idiopathic hyperkinetic state, is a cardiac disorder of unknown etiology, that leads to increased cardiac output, overactivity and responds positively to the administration [symptoma.com]

• Systolic Murmur

  Abstract Twelve men suffering from the primary hyperkinetic heart syndrome (PHHS) displayed palpitation, rapid and forceful heart action, increased pulsations of the large arteries, cardiac systolic murmur, and the following circulatory values (averages [ncbi.nlm.nih.gov]

  PY - 1975 Y1 - 1975 N2 - Twelve men suffering from the primary hyperkinetic heart syndrome (PHHS) displayed palpitation, rapid and forceful heart action, increased pulsations of the large arteries, cardiac systolic murmur, and the following circulatory [moh-it.pure.elsevier.com]

  Cardiac examination reveals a normal S1 and S2, but an ejection systolic murmur is heard too. [lecturio.com]

• Wide Pulse Pressure

  A diffuse apical impulse and wide pulse pressure are also detected. [symptoma.com]

  Signs Wide pulse pressure owing to the leaky flow from the aorta to the pulmonary artery. Prominent carotid pulsations. Hyperkinetic cardiac apex. Accentuated S1 while S2 is narrowly or paradoxically split. [lecturio.com]

• Pansystolic Murmur

  Cardiac auscultation reveals a murmur that can be: Mid-systolic heard along the left sternal border Grade 3 pansystolic murmur over the right precordium Grade 3 basal systolic Grade 2 systolic Grade 4 systolic During the physical examination, the patients [symptoma.com]

  When the defect is small, there is a high-pressure gradient resulting in a continuous pansystolic murmur palpable as a thrill. [lecturio.com]

• Heart Murmur

  Exercise tolerance is normal, and, due to the absence of symptoms, patients are usually referred for a cardiological evaluation for an auscultated heart murmur. The hyperkinetic heart symptom was first described by R. Gorlin in 1959. [symptoma.com]

  Unusual fatigue or shortness of breath with usual activities Although there may be benign origins for these symptoms, they also may signal the onset of, or change in the status of cardiovascular, pulmonary, or metabolic disease. heart murmurs may indicate [quizlet.com]

• Papule

  Erythema Multiforme *: 0-1 : 0.0 % 2-9 : 0.0 % 10-19 : 0.0 % 20-29 : 0.0 % 30-39 : 0.0 % 40-49 : 100 % 50-59 : 0.0 % 60 : 0.0 % Most common drugs for these people *: Diovan: 1 person, 100.00% Top symptoms for these people *: Rash Papular (redness with papule [ehealthme.com]

• Flushing

  It is characterized by prodromal features of presyncope, diaphoresis, a sense of warmth, flushing, nausea, abdominal discomfort, blurry vision, and vision loss. [clevelandclinicmeded.com]

According to the first comprehensive study carried out by Goblin and Brachfeld [5], the hyperkinetic heart syndrome is difficult to diagnose and constitutes a diagnosis made on the basis of clinical suspicion.

Cardiac auscultation reveals a murmur that can be:

• Mid-systolic heard along the left sternal border
• Grade 3 pansystolic murmur over the right precordium
• Grade 3 basal systolic
• Grade 2 systolic
• Grade 4 systolic

During the physical examination, the patients are found to be normotensive or slightly hypertensive, even though an extreme rise in systolic blood pressure is not expected. A diffuse apical impulse and wide pulse pressure are also detected.

An electrocardiogram usually reveals left ventricular hypertrophy or a right ventricular overload with no apparent cause; a right bundle branch block and a prolonged QT interval may be found to co-exist as well. The cold pressor test is generally expected to be positive, illustrating reduced peripheral resistance. Plain radiographs frequently show an enlarged ventricular shadow.

Right heart catheterization provides a diagnostic clue that greatly aids in the diagnosis of the hyperkinetic heart syndrome: it can detect an increased cardiac output, a finding shared by all patients with the disorder. It can also help to differentiate the hyperkinetic heart syndrome from a ventricular septal defect.

Additional blood tests involving a complete blood count and biochemical markers usually reveal no abnormalities, or the abnormalities that are detected are unrelated to the hyperkinetic heart syndrome.

• Ventricular Hypertrophy

  An electrocardiogram usually reveals left ventricular hypertrophy or a right ventricular overload with no apparent cause; a right bundle branch block and a prolonged QT interval may be found to co-exist as well. [symptoma.com]

  ECG abnormalities (usually left ventricular hypertrophy) regressed in the majority. [ncbi.nlm.nih.gov]

  Because Gorlin et al. found a high rate of “flow” murmurs on physical examination of their subjects and electrocardiogram left ventricular hypertrophy ( 2–5 ), it might be useful to evaluate the University of California, San Diego twin/family database [onlinejacc.org]

  License: CC BY-SA 3.0 An enlarged right side of the heart is found in diseases with right atrial and ventricular hypertrophy like ASD, TGA, TAPVC and Ebstein anomaly. A normal sized heart is seen in TOF. [lecturio.com]

1. Gorlin R, Brachfeld N, Turner JD, Messer JV, Salazar E. The idiopathic high cardiac output state. J Clin Invest, 38 (1959), pp. 2144–2153.
2. R. Gorlin. The hyperkinetic heart syndrome. JAMA, 182 (1962), pp. 823–829
3. Gillum RF, Teichholz LE, Herman MV, Gorlin R. The idiopathic hyperkinetic heart syndrome: clinical course and long-term prognosis. Am Heart J, 102 (1981), pp. 728–734.
4. Guazzi M, Polese A, Magrini F, Fiorentini C, Olivari MT. Long-term treatment of hyperkinetic heart syndrome with propranolol. Am J Med Sci. 1975 Nov-Dec;270(3):465-74.
5. Brachfeld N, Gorlin R. Idiopathic hyperkinetic state: a new clinical syndrome. Br Heart J, 22 (1960), pp. 353–360.