Palpitations: Difference between revisions
(Text replacement - "*Troponin" to "*Troponin") |
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===Red flags=== | ===Red flags=== | ||
*Cardiac disease | *Cardiac disease | ||
*Known ECG abnormality | *Known [[ECG]] abnormality | ||
*[[Syncope]]/pre-syncope | *[[Syncope]]/pre-syncope | ||
*Exertional palpitations | *Exertional palpitations | ||
*[[Hypotension]] or relative hypotension | *[[Hypotension]] or relative hypotension | ||
*Heart failure symptoms | *[[Heart failure]] symptoms | ||
==Clinical Features== | ==Clinical Features== | ||
*Sensation of rapid or irregular heart rate | *Sensation of rapid or irregular heart rate | ||
*[[Syncope]] or pre-syncope | *[[Syncope]] or pre-syncope | ||
*Shortness of breath | *[[Shortness of breath]] | ||
*Anxiety | *[[Anxiety]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 23: | Line 23: | ||
*[[ECG]] | *[[ECG]] | ||
*CBC | *CBC | ||
* | *BMP | ||
*TSH | *TSH | ||
*[[CXR]] | *[[CXR]] | ||
*[[Troponin]] in patients with suspicion for underlying heart disease or failure | *[[Troponin]] in patients with suspicion for underlying heart disease or failure | ||
*Consider extended electrolytes | *Consider extended electrolytes (Mg/Phos) | ||
*Consider toxicologic work-up if concern for intoxications | *Consider toxicologic work-up if concern for intoxications | ||
| Line 48: | Line 48: | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Symptoms]] | |||
Revision as of 16:04, 25 September 2019
Background
- Sensation of rapid or irregular heart rate
Red flags
- Cardiac disease
- Known ECG abnormality
- Syncope/pre-syncope
- Exertional palpitations
- Hypotension or relative hypotension
- Heart failure symptoms
Clinical Features
- Sensation of rapid or irregular heart rate
- Syncope or pre-syncope
- Shortness of breath
- Anxiety
Differential Diagnosis
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
Work-Up
- ECG
- CBC
- BMP
- TSH
- CXR
- Troponin in patients with suspicion for underlying heart disease or failure
- Consider extended electrolytes (Mg/Phos)
- Consider toxicologic work-up if concern for intoxications
Diagnosis
- Thyroid exam
- Careful cardiac exam for murmurs
- Cardiac monitoring
- Consider walk test if palpitations primarily present with exertion
Management
- Etiology specific
Disposition
- Etiology specific
- Consideration for Holter monitoring (or similar) with outpatient cardiologist if clinically stable for discharge home
- Recommend avoidance of stimulants and alcohol pending outpatient follow-up