Palpitation diagnostic study of choice
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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
There is no single diagnostic study of choice for palpitations.
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] "Palpitations: Evaluation in the Primary Care Setting - American Family Physician".
| 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.