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Revision as of 20:41, 16 April 2014

Overveiw

Palpitations are one of the most common complains of patients when visiting a physician.^[1]^[2] The causes of palpitations can range from benign (most common) to life-threatening conditions if not managed properly.^[2] Palpitations are described differently by each patient, usually as an uncomfortable awareness of rapid, pounding heart beats, but also described as flip-flopping of the chest, rapid fluttering in the chest or pounding in the neck.^[1]^[2] The diagnosis is made by a detailed history, physical examination and a surface 12-lead EKG. The management of palpitations consists in treating the underlying cause.

Causes

Life-Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.^[1]^[2]^[3]

Characterize the symptoms:

❑ Type of palpitations

❑ Flip-flopping of the chest: (suggestive of extrasystole)

❑ Rapid fluttering of the chest: (suggestive of Tachycardia)

❑ Pounding in the neck: (suggestive of AVRT and AVNRT)

❑ Pulsation palpitations (suggestive of structural heart disease)

❑ Anxiety-related palpitations

❑ Chest pain
❑ Dizziness
❑ Syncope

Inquire about drug that can cause palpitations:

❑ Sympathicomimetic agent pump inhalers (asthmatic patients)
❑ Vasodilators
❑ Anticholinergics
❑ Hydralazine
❑ Whithdrawl of beta-blockers
❑ Alcohol
❑ Cocaine
❑ Heroin
❑ Amphetamines
❑ Caffeine
❑ Nicotine
❑ Cannabis
❑ Synthetic drugs
❑ Weight reaction drugs

Obtain a detailed past medical hystory:

❑ Prevous episodes of palpitations

❑ Number of episodes

❑ Time since last episode

❑ Circumstances of past episodes

❑ Cardiac arrhythmya
❑ Structural heart disease

❑ Hypertrophic cardiomyopathy

❑ Valvular disease

❑ Congenital heart disease

❑ Cardiomegaly

❑ Sistemic diseases

❑ Hyperthyrodism

❑ Pheochromocytoma

❑ History of panic attacks
❑ History of depression

Examine the patient:

Vitals
❑ Pulse
❑ Blood pressure
❑ Respiratory rate
Face ❑
Neck
❑
❑
Respiratory
❑
Cardiovascular
❑
❑
❑
Neurologic
❑
❑

Order labs and tests:

❑ ECG
❑ Electrolytes
❑ TSH
❑ Cardiac enzymes

Order imagin studies

❑ Chest x-ray

References

↑ ^1.0 ^1.1 ^1.2 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.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Zimetbaum, P.; Josephson, ME. (1998). "Evaluation of patients with palpitations". N Engl J Med. 338 (19): 1369–73. doi:10.1056/NEJM199805073381907. PMID 9571258. Unknown parameter |month= ignored (help)
↑ "http://scholar.harvard.edu/files/barkoudah/files/management_of_palpitations.pdf" (PDF). Retrieved 16 April 2014. External link in |title= (help)

Template:WikiDoc Sources

[pmid21697315-1] 1.0 ^1.1 ^1.2 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.

[Zimetbaum-1998-2] 2.0 ^2.1 ^2.2 ^2.3 Zimetbaum, P.; Josephson, ME. (1998). "Evaluation of patients with palpitations". N Engl J Med. 338 (19): 1369–73. doi:10.1056/NEJM199805073381907. PMID 9571258. Unknown parameter |month= ignored (help)

[3] "http://scholar.harvard.edu/files/barkoudah/files/management_of_palpitations.pdf" (PDF). Retrieved 16 April 2014. External link in |title= (help)

[1]

[2]

[3]

@@ Line 18: / Line 18: @@
 ==Complete Diagnostic Approach==
-A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.<ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L et al.| 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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315  }} </ref>
+A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.<ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L et al.| 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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315  }} </ref><ref name="Zimetbaum-1998">{{Cite journal  | last1 = Zimetbaum | first1 = P. | last2 = Josephson | first2 = ME. | title = Evaluation of patients with palpitations. | journal = N Engl J Med | volume = 338 | issue = 19 | pages = 1369-73 | month = May | year = 1998 | doi = 10.1056/NEJM199805073381907 | PMID = 9571258 }}</ref><ref>{{Cite web  | last =  | first =  | title = http://scholar.harvard.edu/files/barkoudah/files/management_of_palpitations.pdf | url = http://scholar.harvard.edu/files/barkoudah/files/management_of_palpitations.pdf | publisher =  | date =  | accessdate = 16 April 2014 }}</ref>
 {{familytree/start}}
 {{familytree | | | | | A01 | | | | |A01=<div style="float: left; text-align: left; width: 24em; padding:1em;">'''Characterize the symptoms:'''<br>
-❑ Flip-flopping of the chest: (suggestive of [[extrasystole]])<br>
+❑ Type of palpitations<br>
-❑ Rapid fluttering of the chest: (suggestive of [[Tachycardia]])<br>
+: ❑ Flip-flopping of the chest: (suggestive of [[extrasystole]])<br>
-❑ Pounding in the neck: (suggestive of AVRT and AVNRT)<br>
+: ❑ Rapid fluttering of the chest: (suggestive of [[Tachycardia]])<br>
-❑ Pulsation palpitations (suggestive of [[structural heart disease]])<br>
+: ❑ Pounding in the neck: (suggestive of AVRT and AVNRT)<br>
-❑ Anxiety-related palpitations<br>
+: ❑ Pulsation palpitations (suggestive of [[structural heart disease]])<br>
+: ❑ Anxiety-related palpitations<br>
+❑ Chest pain<br>
+❑ Dizziness<br>
+❑ Syncope<br>
 </div>}}
 {{familytree | | | | | |!| | | | | | | |}}