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==Overview==
==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.
[[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>==




Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural heard disease, substance abuse or psychiatric disorders.  
[[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 ===
=== Appearance of the Patient ===


* Patients with palpitations may or may not be in distress as it is typically a transient symptom.
* 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.  
* 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.
* Patients with a [[psychiatric  disorder]] such as [[generalized anxiety disorder]] may present with [[psychomotor agitation]] or an [[anxious demeanor]].


=== 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 &#124; 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]].  
* [[Bradycardia]] with regular pulse or irregularly irregular pulse – very rarely seen  
* [[Bradycardia]] with [[regular pulse]] or [[irregularly irregular pulse]] – very rarely seen  
* Pulse discrepancy / Radio-femroal delay  - Coarctation     of aorta
* [[Pulse discrepancy]] / [[Radio-femroal delay]]  - [[Coarctation of aorta]]
* Tachypnea –  Hyperventilation seen in panic disorder
* [[Tachypnea]] –  [[Hyperventilation]] seen in [[panic disorder]]
* Bradypnea – Respiratory depression secondary to substance abuse  
* [[Bradypnea]] – [[Respiratory depression]] secondary to [[substance abuse]]
* Possible signs of orthostatic hypotension – Dehydration or electrolyte     imbalance.  
* Possible signs of [[orthostatic hypotension]] – [[Dehydration]] or [[electrolyte imbalance]].  


=== Skin ===
=== Skin ===


* Heat intolerance – Hyperthyroidism
* Heat intolerance – [[Hyperthyroidism]]
* Cold intolerance – Hypothyroidism
* Cold intolerance – [[Hypothyroidism]]
* Dry skin with discoloration – Hypothyroidism
* Dry skin with discoloration – [[Hypothyroidism]]
* Diaphoresis – Substance abuse,hyperthyroidism
* [[Diaphoresis]] – [[Substance abuse]],[[hyperthyroidism]]
* [[Pallor]] – Anemia  
* [[Pallor]] – [[Anemia]]


=== HEENT ===
=== HEENT ===


* Exophthalmos – Hyperthyroidism
* [[Exophthalmos]] – [[Hyperthyroidism]]
* Pupils may be dilated – Indicative of substance abuse ; cocaine, amphetamines
* [[Pupils]] may be [[dilated]] – Indicative of [[substance abuse]] ; [[cocaine]], [[amphetamines]]


=== Neck ===
=== Neck ===


* [[Jugular venous distension]] – secondary to congestive heart failure
* [[Jugular venous distension]] – secondary to [[congestive heart failure]]
* [[Thyromegaly]] / thyroid nodules – causing hyperthyroidism/ hypothyroidism
* [[Thyromegaly]] / [[thyroid nodules]] – causing [[hyperthyroidism]]/ [[hypothyroidism]]
* [[Hepatojugular reflux]] – Indicative of constrictive pericarditis, restrictive cardiomyopathy or right heart failure.  
* [[Hepatojugular reflux]] – Indicative of [[constrictive pericarditis]], [[restrictive cardiomyopathy]] or [[right heart failure]].  
* Pounding pulsations – may be seen in AV nodal re-entry tachycardia  
* [[Pounding pulsations]] – may be seen in AV nodal re-entry [[tachycardia]]


=== Lungs ===
=== Lungs ===


* 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]].  
* [[Friction rub]] – Pericarditis  
* [[Friction rub]] – [[Pericarditis]]
* [[Heart sounds#Second heart tone S2 the %22dub%22(components A2 and P2)|S2]] – fixed splitting of S2 along with a right ventricular heave is indicative of an atrial septal defect
* [[Heart sounds#Second heart tone S2 the %22dub%22(components A2 and P2)|S2]] – [[fixed splitting of S2]] along with a [[right ventricular heave]] is indicative of an [[atrial septal defect]]
* [[Heart sounds#Third heart sound S3|S3]] – Congestive heart failure  
* [[Heart sounds#Third heart sound S3|S3]] – [[Congestive heart failure]]
* [[Heart sounds#Fourth heart sound S4|S4]] –  Chronic valvular heart disease  
* [[Heart sounds#Fourth heart sound S4|S4]] –  [[Chronic valvular heart disease]]
* A harsh pansystolic murmur best heard over the left sternal border and increases with Vasalva –  Hypertrophic cardiomyopathy.  
* A harsh [[pansystolic murmur]] best heard over the left [[sternal border]] and increases with [[Vasalva]] –  [[Hypertrophic cardiomyopathy]].  
* Mid systolic click - Mitral valve prolapse  
* [[Mid systolic click]] - [[Mitral valve prolapse]]
* Systolic murmur best heard  over the pulmonic area – Pulmonic stenosis
* [[Systolic murmur]] best heard  over the [[pulmonic area]] – [[Pulmonic stenosis]]


=== Abdomen ===
=== Abdomen ===


* Ascites – Right heart failure  
* [[Ascites]] – [[Right heart failure]]
* Congestive hepatomegaly  
* [[Congestive hepatomegaly]]


=== Back ===
=== Back ===


* 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.


=== 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 &#124; 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]]
* Unilateral/bilateral tremor – Hyperthyroidism  
* [[Unilateral]]/[[bilateral]] [[tremor]] – [[Hyperthyroidism]]


=== Extremities ===
=== [[Extremities]] ===


* Pitting edema – Congestive heart failure
* [[Pitting edema]] – [[Congestive heart failure]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 17:57, 31 January 2021

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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

Vital Signs

Skin

HEENT

Neck

Lungs

Heart [6][7] [7] [7] [8] [9]

Abdomen

Back

  • Back examination of patients with palpitations is usually normal.

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ 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).
  5. ↑ Fraser S, Evans MF (1997). "Diagnosis and prognosis of patients with palpitations". Can Fam Physician. 43: 2131–2. PMC 2255099. PMID 9426932.
  6. ↑ Wexler RK, Pleister A, Raman S (2011). "Outpatient approach to palpitations". Am Fam Physician. 84 (1): 63–9. PMID 21766757.
  7. ↑ 7.0 7.1 7.2 "StatPearls". 2020. PMID 28613787.
  8. ↑ Wexler RK, Pleister A, Raman SV (2017). "Palpitations: Evaluation in the Primary Care Setting". Am Fam Physician. 96 (12): 784–789. PMID 29431371.
  9. ↑ 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.
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