Palpitation physical examination: Difference between revisions
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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== | ||
Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural | [[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]] | ||
* 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 | * [[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 | * 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 === | ||
* 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]] | ||
* 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== | ||
Revision as of 07:09, 16 August 2020
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Palpitation physical examination On the Web |
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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
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
- 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
- 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
- Hyporeflexia – Hypothyroidism
- Proximal/distal muscle weakness unilaterally/bilaterally – Hypothyroidism
- Unilateral/bilateral tremor – Hyperthyroidism