Palpitation physical examination: Difference between revisions
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[[Palpitations]] are typically a [[transient]] [[symptoms]]. Patients may or may not be in [[physical distress]] and may even present with [[altered mental status]] secondary to [[substance abuse]]. During a [[physical examination]] one must look for [[signs]] and [[symptoms]] of [[hyperthyroidism]], [[hypothyroidism]], [[congestive heart failure]], [[rhythm disturbances]] and [[structural heart disease]]. | [[Palpitations]] are typically a [[transient]] [[symptoms]]. Patients may or may not be in [[physical distress]] and may even present with [[altered mental status]] secondary to [[substance abuse]]. During a [[physical examination]] one must look for [[signs]] and [[symptoms]] of [[hyperthyroidism]], [[hypothyroidism]], [[congestive heart failure]], [[rhythm disturbances]] and [[structural heart disease]]. | ||
==Physical Examination== | ==Physical Examination <ref name="pmid10458728">{{cite journal| author=Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A | display-authors=etal| title=ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). | journal=Circulation | year= 1999 | volume= 100 | issue= 8 | pages= 886-93 | pmid=10458728 | doi=10.1161/01.cir.100.8.886 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10458728 }} </ref> <ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | doi=10.1016/s0002-9343(97)89451-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629647 }} </ref> <ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | doi=10.1016/s0002-9343(97)89451-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629647 }} </ref> <ref name="pmid29995805">{{cite journal| author=Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L | display-authors=etal| title=Benefits of an early management of palpitations. | journal=Medicine (Baltimore) | year= 2018 | volume= 97 | issue= 28 | pages= e11466 | pmid=29995805 | doi=10.1097/MD.0000000000011466 | pmc=6076186 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29995805 }} </ref> <ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29995805">{{cite journal| author=Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L | display-authors=etal| title=Benefits of an early management of palpitations. | journal=Medicine (Baltimore) | year= 2018 | volume= 97 | issue= 28 | pages= e11466 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29995805 | doi=10.1097/MD.0000000000011466 | pmc=6076186 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29995805 }} </ref> <ref name="pmid9426932">{{cite journal| author=Fraser S, Evans MF| title=Diagnosis and prognosis of patients with palpitations. | journal=Can Fam Physician | year= 1997 | volume= 43 | issue= | pages= 2131-2 | pmid=9426932 | doi= | pmc=2255099 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9426932 }} </ref>== | ||
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=== Vital Signs === | === Vital Signs === | ||
* [[Tachycardia]] with [[regular pulse]] or [[irregularly irregular pulse]] | * [[Tachycardia]] with [[regular pulse]] or [[irregularly irregular pulse]] {{cite web |url=https://www1.racgp.org.au/ajgp/2019/april/approach-to-palpitations/ |title=RACGP - Approach to palpitations |format= |work= |accessdate=}} {{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview | ScienceDirect Topics |format= |work= |accessdate=}} {{cite web |url=https://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/palpitations |title=Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}} {{cite web |url=https://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/palpitations |title=Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}} | ||
* An [[irregular pulse]] may indicate [[atrial fibrillation]] or [[atrial flutter]]. | * An [[irregular pulse]] may indicate [[atrial fibrillation]] or [[atrial flutter]]. | ||
* A [[regular pulse]] may indicate [[sinus tachycardia]] or [[paroxysmal supraventricular tachycardia]]. | * A [[regular pulse]] may indicate [[sinus tachycardia]] or [[paroxysmal supraventricular tachycardia]]. | ||
| Line 54: | Line 54: | ||
* [[Fine/coarse bibasilar]] [[crackles]] upon [[auscultation]] – [[Congestive heart failure]] | * [[Fine/coarse bibasilar]] [[crackles]] upon [[auscultation]] – [[Congestive heart failure]] | ||
=== Heart === | === Heart <ref name="pmid21766757">{{cite journal| author=Wexler RK, Pleister A, Raman S| title=Outpatient approach to palpitations. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 1 | pages= 63-9 | pmid=21766757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21766757 }} </ref><ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid29431371">{{cite journal| author=Wexler RK, Pleister A, Raman SV| title=Palpitations: Evaluation in the Primary Care Setting. | journal=Am Fam Physician | year= 2017 | volume= 96 | issue= 12 | pages= 784-789 | pmid=29431371 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29431371 }} </ref> <ref name="pmid31256490">{{cite journal| author=McLellan AJ, Kalman JM| title=Approach to palpitations. | journal=Aust J Gen Pract | year= 2019 | volume= 48 | issue= 4 | pages= 204-209 | pmid=31256490 | doi=10.31128/AJGP-12-17-4436 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31256490 }} </ref>=== | ||
* Displaced [[point of maximal impulse]] (PMI) suggestive of [[left ventricular hypertrophy]] or [[cardiomegaly]]. | * Displaced [[point of maximal impulse]] (PMI) suggestive of [[left ventricular hypertrophy]] or [[cardiomegaly]]. | ||
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* Back examination of patients with [[palpitations]] is usually normal. | * Back examination of patients with [[palpitations]] is usually normal. | ||
=== Genitourinary === | === Genitourinary === | ||
* [[Genitourinary examination]] of patients with [[palpitations]] is usually normal. | * [[Genitourinary examination]] of patients with [[palpitations]] is usually normal. | ||
| Line 80: | Line 80: | ||
=== [[Neuromuscular]] === | === [[Neuromuscular]] === | ||
* Patient is usually [[oriented]] to persons, place, and time | * Patient is usually [[oriented]] to persons, place, and time | ||
* [[Altered mental status]] – [[Myxedema madness]], [[alcohol]] consumption | * [[Altered mental status]] – [[Myxedema madness]], [[alcohol]] consumption | ||
* [[Hyperreflexia]] – [[Hyperthyroidism]] | * [[Hyperreflexia]] – [[Hyperthyroidism]] {{cite web |url=https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.566760 |title=Palpitations | Circulation |format= |work= |accessdate=}} {{cite web |url=https://doi.org/10.1016/j.amjmed.2010.01.012 |title=Redirecting |format= |work= |accessdate=}} {{cite web |url=+https://doi.org/10.1002/joa3.12358 |title=Isolated palpitations and ventricular pre‐excitation - Arias - 2020 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}} {{cite web |url=https://www.aafp.org/afp/2017/1215/p784.html |title=Palpitations: Evaluation in the Primary Care Setting - American Family Physician |format= |work= |accessdate=}} | ||
* [[Hyporeflexia]] – [[Hypothyroidism]] | * [[Hyporeflexia]] – [[Hypothyroidism]] | ||
* [[Proximal/distal muscle weakness]] [[unilaterally]]/[[bilaterally]] – [[Hypothyroidism]] | * [[Proximal/distal muscle weakness]] [[unilaterally]]/[[bilaterally]] – [[Hypothyroidism]] | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 17:57, 31 January 2021
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Palpitation Microchapters |
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Palpitation physical examination On the Web |
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American Roentgen Ray Society Images of Palpitation physical examination |
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Risk calculators and risk factors for Palpitation physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]
Overview
Palpitations are typically a transient symptoms. Patients may or may not be in physical distress and may even present with altered mental status secondary to substance abuse. During a physical examination one must look for signs and symptoms of hyperthyroidism, hypothyroidism, congestive heart failure, rhythm disturbances and structural heart disease.
Physical Examination [1] [2] [2] [3] [4] [5]
Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural heart disease, substance abuse or psychiatric disorders.
Appearance of the Patient
- Patients with palpitations may or may not be in distress as it is typically a transient symptom.
- Patient may exhibit aggressive/aberrant behavior suggestive of possible substance abuse.
- Patients with a psychiatric disorder such as generalized anxiety disorder may present with psychomotor agitation or an anxious demeanor.
Vital Signs
- Tachycardia with regular pulse or irregularly irregular pulse "RACGP - Approach to palpitations". "Palpitations - an overview | ScienceDirect Topics". "Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition". "Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition".
- An irregular pulse may indicate atrial fibrillation or atrial flutter.
- A regular pulse may indicate sinus tachycardia or paroxysmal supraventricular tachycardia.
- Bradycardia with regular pulse or irregularly irregular pulse – very rarely seen
- Pulse discrepancy / Radio-femroal delay - Coarctation of aorta
- Tachypnea – Hyperventilation seen in panic disorder
- Bradypnea – Respiratory depression secondary to substance abuse
- Possible signs of orthostatic hypotension – Dehydration or electrolyte imbalance.
Skin
- Heat intolerance – Hyperthyroidism
- Cold intolerance – Hypothyroidism
- Dry skin with discoloration – Hypothyroidism
- Diaphoresis – Substance abuse,hyperthyroidism
- Pallor – Anemia
HEENT
- Exophthalmos – Hyperthyroidism
- Pupils may be dilated – Indicative of substance abuse ; cocaine, amphetamines
Neck
- Jugular venous distension – secondary to congestive heart failure
- Thyromegaly / thyroid nodules – causing hyperthyroidism/ hypothyroidism
- Hepatojugular reflux – Indicative of constrictive pericarditis, restrictive cardiomyopathy or right heart failure.
- Pounding pulsations – may be seen in AV nodal re-entry tachycardia
Lungs
Heart [6][7] [7] [7] [8] [9]
- Displaced point of maximal impulse (PMI) suggestive of left ventricular hypertrophy or cardiomegaly.
- Friction rub – Pericarditis
- S2 – fixed splitting of S2 along with a right ventricular heave is indicative of an atrial septal defect
- S3 – Congestive heart failure
- S4 – Chronic valvular heart disease
- A harsh pansystolic murmur best heard over the left sternal border and increases with Vasalva – Hypertrophic cardiomyopathy.
- Mid systolic click - Mitral valve prolapse
- Systolic murmur best heard over the pulmonic area – Pulmonic stenosis
Abdomen
Back
- Back examination of patients with palpitations is usually normal.
Genitourinary
- Genitourinary examination of patients with palpitations is usually normal.
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Altered mental status – Myxedema madness, alcohol consumption
- Hyperreflexia – Hyperthyroidism "Palpitations | Circulation". "Redirecting". [+https://doi.org/10.1002/joa3.12358 "Isolated palpitations and ventricular pre‐excitation - Arias - 2020 - Journal of Arrhythmia - Wiley Online Library"] Check
|url=value (help). "Palpitations: Evaluation in the Primary Care Setting - American Family Physician". - Hyporeflexia – Hypothyroidism
- Proximal/distal muscle weakness unilaterally/bilaterally – Hypothyroidism
- Unilateral/bilateral tremor – Hyperthyroidism
Extremities
References
- ↑ Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A; et al. (1999). "ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography)". Circulation. 100 (8): 886–93. doi:10.1161/01.cir.100.8.886. PMID 10458728.
- ↑ 2.0 2.1 Weber BE, Kapoor WN (1996). "Evaluation and outcomes of patients with palpitations". Am J Med. 100 (2): 138–48. doi:10.1016/s0002-9343(97)89451-x. PMID 8629647.
- ↑ Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L; et al. (2018). "Benefits of an early management of palpitations". Medicine (Baltimore). 97 (28): e11466. doi:10.1097/MD.0000000000011466. PMC 6076186. PMID 29995805.
- ↑ Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L; et al. (2018). "Benefits of an early management of palpitations". Medicine (Baltimore). 97 (28): e11466. doi:10.1097/MD.0000000000011466. PMC 6076186. PMID https://www.ncbi.nlm.nih.gov/pubmed/29995805 Check
|pmid=value (help). - ↑ Fraser S, Evans MF (1997). "Diagnosis and prognosis of patients with palpitations". Can Fam Physician. 43: 2131–2. PMC 2255099. PMID 9426932.
- ↑ Wexler RK, Pleister A, Raman S (2011). "Outpatient approach to palpitations". Am Fam Physician. 84 (1): 63–9. PMID 21766757.
- ↑ 7.0 7.1 7.2 "StatPearls". 2020. PMID 28613787.
- ↑ Wexler RK, Pleister A, Raman SV (2017). "Palpitations: Evaluation in the Primary Care Setting". Am Fam Physician. 96 (12): 784–789. PMID 29431371.
- ↑ McLellan AJ, Kalman JM (2019). "Approach to palpitations". Aust J Gen Pract. 48 (4): 204–209. doi:10.31128/AJGP-12-17-4436. PMID 31256490.