Palpitations: Difference between revisions
| Line 21: | Line 21: | ||
==Evaluation== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
*[[ECG]] | |||
*CBC | *CBC | ||
*Chem | *Chem | ||
*TSH | *TSH | ||
*[[CXR]] | *[[CXR]] | ||
* | *Troponin in patients with suspicion for underlying heart disease or failure | ||
* | *Consider extended electrolytes | ||
*Consider toxicologic work-up if concern for intoxications | |||
===Evaluation=== | ===Evaluation=== | ||
Revision as of 15:41, 9 March 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
- Chem
- TSH
- CXR
- Troponin in patients with suspicion for underlying heart disease or failure
- Consider extended electrolytes
- Consider toxicologic work-up if concern for intoxications
Evaluation
- Thyroid exam
- Careful cardiac exam for murmurs
- Consider cardiac monitoring if perisistent
Management
- Etiology specific
Disposition
- Etiology specific.
- Consideration for Holter monitoring (or similar) with outpatient provider.