Palpitations: Difference between revisions
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(Text replacement - "*Troponin" to "*Troponin") |
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==Background== | ==Background== | ||
*Sensation of rapid or irregular heart rate | |||
===Red flags=== | ===Red flags=== | ||
*Cardiac disease | *Cardiac disease | ||
*Known | *Known ECG abnormality | ||
*[[Syncope]]/pre-syncope | *[[Syncope]]/pre-syncope | ||
*Exertional palpitations | *Exertional palpitations | ||
| Line 10: | Line 12: | ||
==Clinical Features== | ==Clinical Features== | ||
*Sensation of rapid or irregular heart rate | *Sensation of rapid or irregular heart rate | ||
*[[Syncope]] or pre-syncope | |||
*Shortness of breath | |||
*Anxiety | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Palpitations DDX}} | {{Palpitations DDX}} | ||
== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
*[[ECG]] | |||
*CBC | *CBC | ||
*Chem | *Chem | ||
*TSH | *TSH | ||
* | *[[CXR]] | ||
* | *[[Troponin]] in patients with suspicion for underlying heart disease or failure | ||
* | *Consider extended electrolytes | ||
* | *Consider toxicologic work-up if concern for intoxications | ||
=== | ===Diagnosis=== | ||
*Thyroid exam | *Thyroid exam | ||
*Careful cardiac exam for murmurs | *Careful cardiac exam for murmurs | ||
*Consider | *Cardiac monitoring | ||
*Consider walk test if palpitations primarily present with exertion | |||
==Management== | ==Management== | ||
| Line 34: | Line 41: | ||
==Disposition== | ==Disposition== | ||
*Etiology specific | *Etiology specific | ||
*Consideration for Holter monitoring (or similar) with outpatient cardiologist if clinically stable for discharge home | |||
*Recommend avoidance of stimulants and alcohol pending outpatient follow-up | |||
==See Also== | ==See Also== | ||
Revision as of 20:48, 1 July 2019
Background
- Sensation of rapid or irregular heart rate
Red flags
- Cardiac disease
- Known ECG abnormality
- Syncope/pre-syncope
- Exertional palpitations
- Hypotension or relative hypotension
- Heart failure symptoms
Clinical Features
- Sensation of rapid or irregular heart rate
- Syncope or pre-syncope
- Shortness of breath
- Anxiety
Differential Diagnosis
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
Work-Up
- ECG
- CBC
- Chem
- TSH
- CXR
- Troponin in patients with suspicion for underlying heart disease or failure
- Consider extended electrolytes
- Consider toxicologic work-up if concern for intoxications
Diagnosis
- Thyroid exam
- Careful cardiac exam for murmurs
- Cardiac monitoring
- Consider walk test if palpitations primarily present with exertion
Management
- Etiology specific
Disposition
- Etiology specific
- Consideration for Holter monitoring (or similar) with outpatient cardiologist if clinically stable for discharge home
- Recommend avoidance of stimulants and alcohol pending outpatient follow-up