Palpitations: Difference between revisions
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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 | ||
*[[Hypotension]] or relative hypotension | *[[Hypotension]] or relative hypotension | ||
*Heart failure symptoms | *[[Heart failure]] symptoms | ||
==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 | ||
* | *BMP | ||
*TSH | *TSH | ||
* | *[[CXR]] | ||
* | *[[Troponin]] in patients with suspicion for underlying heart disease or failure | ||
* | *Consider extended electrolytes (Mg/Phos) | ||
* | *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== | ||
*Etiology specific | *Etiology specific | ||
==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 | |||
*Criteria for admission from Management of patients with palpitations: a position paper from the European Heart Rhythm Association<ref>Antonio Raviele, Franco Giada, Lennart Bergfeldt, Jean Jacques Blanc, Carina Blomstrom-Lundqvist, Lluis Mont, John M. Morgan, M.J. Pekka Raatikainen, Gerhard Steinbeck, Sami Viskin, Document reviewers, Paulus Kirchhof, Frieder Braunschweig, Martin Borggrefe, Meleze Hocini, Paolo Della Bella, Dipen Chandrakant Shah, Management of patients with palpitations: a position paper from the European Heart Rhythm Association, EP Europace, Volume 13, Issue 7, July 2011, Pages 920–934, https://doi.org/10.1093/europace/eur130</ref> | |||
[[File:Criteria for the hospitalization of patients with palpitations.png|thumb|Criteria for the hospitalization of patients with palpitations from Management of patients with palpitations: a position paper from the European Heart Rhythm Association, EP Europace, Volume 13, Issue 7, July 2011, Pages 920–934, https://doi.org/10.1093/europace/eur130]] | |||
==See Also== | ==See Also== | ||
*[[Atrial Fibrillation]] | *[[Atrial Fibrillation]] | ||
[[Category: | [[Category:Cardiology]] | ||
[[Category:Symptoms]] | |||
Latest revision as of 19:08, 14 December 2020
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
- BMP
- TSH
- CXR
- Troponin in patients with suspicion for underlying heart disease or failure
- Consider extended electrolytes (Mg/Phos)
- 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
- Criteria for admission from Management of patients with palpitations: a position paper from the European Heart Rhythm Association[1]
Criteria for the hospitalization of patients with palpitations from Management of patients with palpitations: a position paper from the European Heart Rhythm Association, EP Europace, Volume 13, Issue 7, July 2011, Pages 920–934, https://doi.org/10.1093/europace/eur130
See Also
- ↑ Antonio Raviele, Franco Giada, Lennart Bergfeldt, Jean Jacques Blanc, Carina Blomstrom-Lundqvist, Lluis Mont, John M. Morgan, M.J. Pekka Raatikainen, Gerhard Steinbeck, Sami Viskin, Document reviewers, Paulus Kirchhof, Frieder Braunschweig, Martin Borggrefe, Meleze Hocini, Paolo Della Bella, Dipen Chandrakant Shah, Management of patients with palpitations: a position paper from the European Heart Rhythm Association, EP Europace, Volume 13, Issue 7, July 2011, Pages 920–934, https://doi.org/10.1093/europace/eur130