Palpitation diagnostic study of choice: Difference between revisions
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*There is no single diagnostic study of choice for the diagnosis of palpitations, but palpitations can be diagnosed based on a through initial evaluation (a detailed history, physical examination and 12 lead ECG). | *There is no single diagnostic study of choice for the diagnosis of palpitations, but palpitations can be diagnosed based on a through initial evaluation (a detailed history, physical examination and 12 lead ECG). | ||
*Following this, investigative modalities such as an echocardiography, electrophysiologic study, a different forms of ambulatory ECG monitoring and laboratory investigations such as a renal function test, thyroid function tests and serum drug levels may be employed. | *Following this, investigative modalities such as an echocardiography, electrophysiologic study, a different forms of ambulatory ECG monitoring and laboratory investigations such as a renal function test, thyroid function tests and serum drug levels may be employed. | ||
*The following algorithm can be employed when approaching a patient presenting with palpitations. <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><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><ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L | display-authors=etal| title=Management of patients with palpitations: a position paper from the European Heart Rhythm Association. | journal=Europace | year= 2011 | volume= 13 | issue= 7 | pages= 920-34 | pmid=21697315 | doi=10.1093/europace/eur130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315 }} </ref><ref name="pmid23177608">{{cite journal| author=Jamshed N, Dubin J, Eldadah Z| title=Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options. | journal=Clin Geriatr Med | year= 2013 | volume= 29 | issue= 1 | pages= 205-30 | pmid=23177608 | doi=10.1016/j.cger.2012.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177608 }} </ref>{{cite journal |vauthors=Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Khuchua TO, Sukhareva BS, Granström G, Linde A |title=Coronary vascular and myocardial responses to carotid body stimulation in the dog |journal=Am. J. Physiol. |volume=229 |issue=3 |pages=754–60 |date=September 1975 |pmid=2017 |doi=10.1152/ajplegacy.1975.229.3.754 |url=}} | *The following algorithm can be employed when approaching a patient presenting with palpitations. <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><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><ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L | display-authors=etal| title=Management of patients with palpitations: a position paper from the European Heart Rhythm Association. | journal=Europace | year= 2011 | volume= 13 | issue= 7 | pages= 920-34 | pmid=21697315 | doi=10.1093/europace/eur130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315 }} </ref><ref name="pmid23177608">{{cite journal| author=Jamshed N, Dubin J, Eldadah Z| title=Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options. | journal=Clin Geriatr Med | year= 2013 | volume= 29 | issue= 1 | pages= 205-30 | pmid=23177608 | doi=10.1016/j.cger.2012.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177608 }} </ref> {{cite journal |vauthors=Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Khuchua TO, Sukhareva BS, Granström G, Linde A |title=Coronary vascular and myocardial responses to carotid body stimulation in the dog |journal=Am. J. Physiol. |volume=229 |issue=3 |pages=754–60 |date=September 1975 |pmid=2017 |doi=10.1152/ajplegacy.1975.229.3.754 |url=}} | ||
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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
Diagnostic Study of Choice
- There is no single diagnostic study of choice for the diagnosis of palpitations, but palpitations can be diagnosed based on a through initial evaluation (a detailed history, physical examination and 12 lead ECG).
- Following this, investigative modalities such as an echocardiography, electrophysiologic study, a different forms of ambulatory ECG monitoring and laboratory investigations such as a renal function test, thyroid function tests and serum drug levels may be employed.
- The following algorithm can be employed when approaching a patient presenting with palpitations. [1][2][3][4] Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Khuchua TO, Sukhareva BS, Granström G, Linde A (September 1975). "Coronary vascular and myocardial responses to carotid body stimulation in the dog". Am. J. Physiol. 229 (3): 754–60. doi:10.1152/ajplegacy.1975.229.3.754. PMID 2017.
| Palpitations | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hemodynamically stable | Hemodynamically unstable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History, Physical examination and 12 Lead ECG | Follow ACLS protocol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive ECG Findings | Systemic/pharmacological cause | Cause not established | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Appropriate laboratory investigations/cessation of causative drug | Frequent/distressing Episodes | Rare/well Tolerated Episodes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Plan for definitive treatment | Ambulatory EKG monitoring | No further workup | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cardiology Referral | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Arrhythmia | Structural Heart Disease | Myocardial Ischemia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treat accordingly or plan for discharge if benign | Perform echocardiography | Urgent treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cardiology referral | Cardiology referral | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Abbott AV (2005). "Diagnostic approach to palpitations". Am Fam Physician. 71 (4): 743–50. PMID 15742913.
- ↑ 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.
- ↑ Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L; et al. (2011). "Management of patients with palpitations: a position paper from the European Heart Rhythm Association". Europace. 13 (7): 920–34. doi:10.1093/europace/eur130. PMID 21697315.
- ↑ Jamshed N, Dubin J, Eldadah Z (2013). "Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options". Clin Geriatr Med. 29 (1): 205–30. doi:10.1016/j.cger.2012.10.003. PMID 23177608.