Palpitation medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The treatment strategy for [[patients]] presenting with [[palpitation]] is directed towards treating the underlying [[cause]]. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup. | The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]]. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*The treatment strategy for [[patients]] presenting with [[palpitation]] is directed towards treating the underlying [[cause]]. | *The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]]. | ||
*A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup. | *A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup. | ||
*[[Patients]] with no positive findings in their initial [[physical examination]] and [[12 lead ECG]] may be discharged with the advice to follow up with a [[cardiologist]]. <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref> | *[[Patients]] with no positive findings in their initial [[physical examination]] and [[12 lead ECG]] may be discharged with the advice to follow up with a [[cardiologist]]. <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref> | ||
* | *[[Patient]]s with documented [[arrythmias]] or worrying symptoms such as [[presyncope]], [[syncope]], [[chest pain]], [[dyspnea]] or [[hemodynamic instability]] require further treatment. | ||
*To elucidate the treatment of every underlying cause is beyond the scope of this chapter. | *To elucidate the treatment of every underlying cause is beyond the scope of this chapter. | ||
*[[Arrythmias]] may be treated with [[antiarrhythmics]] or [[invasive electrophysiologic management]]. <ref name="pmid15742913">{{cite journal| author=Abbott AV| title=Diagnostic approach to palpitations. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 4 | pages= 743-50 | pmid=15742913 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15742913 }} </ref> | *[[Arrythmias]] may be treated with [[antiarrhythmics]] or [[invasive electrophysiologic management]]. <ref> name="pmid15742913">{{cite journal| author=Abbott AV| title=Diagnostic approach to palpitations. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 4 | pages= 743-50 | pmid=15742913 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15742913 }} </ref> | ||
**[[Premature ventricular contractions]] may be treated with [[beta blockers]], [[amiodarone]] or may be left alone if it is an isolated incident and the [[heart]] is structurally normal. | **[[Premature ventricular contractions]] may be treated with [[beta blockers]], [[amiodarone]] or may be left alone if it is an isolated incident and the [[heart]] is structurally normal. | ||
**In general, [[ventricular and atrial ectopics]] are commonly [[benign]] and reassurance along with withdrawal of [[precipitants]] (caffeine, alcohol) is the best treatment in such cases. {{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview | ScienceDirect Topics |format= |work= |accessdate=}} | **In general, [[ventricular and atrial ectopics]] are commonly [[benign]] and reassurance along with withdrawal of [[precipitants]] (caffeine, alcohol) is the best treatment in such cases.<ref>{{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview | ScienceDirect Topics |format= |work= |accessdate=}}</ref> | ||
*The treatment of [[atrial fibrillation]] and [[atrial flutter]] involves [[rate control]], [[rhythm control]] and [[risk stratification]] for [[ | *The treatment of [[atrial fibrillation]] and [[atrial flutter]] involves [[rate control]], [[rhythm control]] and [[risk stratification]] for systemic [[anticoagulation]]. | ||
**[[Paroxysmal supraventricular tachycardias]] may be treated with [[vagal maneuvers]], [[antiarrhythmics]] such as [[cardioselective beta blockers]], [[adenosine]] or [[non dihydropyridine calcium channel blockers]]. [[Ablation]] and [[synchronized cardioversion]] are reserved for [[haemodynamically unstable]] patients. | **[[Paroxysmal supraventricular tachycardias]] may be treated with [[vagal maneuvers]], [[antiarrhythmics]] such as [[cardioselective beta blockers]], [[adenosine]] or [[non dihydropyridine calcium channel blockers]]. [[Ablation]] and [[synchronized cardioversion]] are reserved for [[haemodynamically unstable]] patients. | ||
**Sustained [[ventricular tachycardias]] with high risk features like an [[ejection fraction]] < 40% , [[family history]] of [[sudden cardiac death]] or a [[past history]] of [[structural heart disease]] may be referred for an [[electrophysiology study]] or [[implantable cardioverter defibrillator placement]]. | **Sustained [[ventricular tachycardias]] with high risk features like an [[ejection fraction]] < 40% , [[family history]] of [[sudden cardiac death]] or a [[past history]] of [[structural heart disease]] may be referred for an [[electrophysiology study]] or [[implantable cardioverter defibrillator placement]]. | ||
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[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Up-To-Date]] | |||
Latest revision as of 19:58, 21 January 2021
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Palpitation Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Palpitation medical therapy On the Web |
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American Roentgen Ray Society Images of Palpitation medical therapy |
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Risk calculators and risk factors for Palpitation medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]
Overview
The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.
Medical Therapy
- The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause.
- A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.
- Patients with no positive findings in their initial physical examination and 12 lead ECG may be discharged with the advice to follow up with a cardiologist. [1]
- Patients with documented arrythmias or worrying symptoms such as presyncope, syncope, chest pain, dyspnea or hemodynamic instability require further treatment.
- To elucidate the treatment of every underlying cause is beyond the scope of this chapter.
- Arrythmias may be treated with antiarrhythmics or invasive electrophysiologic management. [2]
- Premature ventricular contractions may be treated with beta blockers, amiodarone or may be left alone if it is an isolated incident and the heart is structurally normal.
- In general, ventricular and atrial ectopics are commonly benign and reassurance along with withdrawal of precipitants (caffeine, alcohol) is the best treatment in such cases.[3]
- The treatment of atrial fibrillation and atrial flutter involves rate control, rhythm control and risk stratification for systemic anticoagulation.
- Paroxysmal supraventricular tachycardias may be treated with vagal maneuvers, antiarrhythmics such as cardioselective beta blockers, adenosine or non dihydropyridine calcium channel blockers. Ablation and synchronized cardioversion are reserved for haemodynamically unstable patients.
- Sustained ventricular tachycardias with high risk features like an ejection fraction < 40% , family history of sudden cardiac death or a past history of structural heart disease may be referred for an electrophysiology study or implantable cardioverter defibrillator placement.
- Depending on the degree of heart block, treatment may include reassurance, antiarrhythmics or temporary/permanent pacing.
- Structural heart disease such as hypertrophic cardiomyopathy, severe valvular heart disease and congenital heart defects may be treated surgically.
- Antidotes, behavioral therapy and cessation of drug intake would be the treatment strategy employed for palpitations secondary to substance abuse.
References
- ↑ "StatPearls". 2020. PMID 28613787.
- ↑ name="pmid15742913">Abbott AV (2005). "Diagnostic approach to palpitations". Am Fam Physician. 71 (4): 743–50. PMID 15742913.
- ↑ "Palpitations - an overview | ScienceDirect Topics".