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Palpitations are one of the most common complains of patients when visiting a physician. The causes of palpitations can range from benign (most common) to life-threatening conditions if not managed properly. 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. 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.

• Acute coronary syndrome
• Malignant hypertension
• Myocardial infarction
• Third degree AV block
• Ventricular arrhythmia

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.

{{familytree | | | | | D01 | | | | | |D01=Examine the patient:
Vitals
❑ Pulse
❑ Blood pressure
❑ Respiratory rate
Face ❑
Neck
❑
❑
Respiratory
❑
Cardiovascular
❑
❑
❑
Neurologic
❑
❑

{{familytree | | | | | E01 | | | | | |E01=Order labs and tests:
❑ ECG
❑ Electrolytes
❑ TSH
❑ Cardiac enzymes

{{familytree | | | | | F01 | | | | |F01=Order imagin studies
❑ Chest x-ray

Characterize the symptoms:

Inquire about drug that can cause palpitations:

Obtain a detailed past medical hystory:

References

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