Outpatient / Cardiology
Palpitations
#Palpitations
Intake:
-- Onset: ***
-- Duration: ***
-- Timing: ***
-- Lifestyle: *** (caffeine, alcohol, other drugs, sleep, stress)
-- Red Flags: *** (palpitations last more than a few seconds at a time, known CHF, prior ischemia, syncope, new murmurs, worse with exertion)
-- Prior EKG: ***
-- Prior Echo: **
-- Prior Stress: ***
DDx:
-- Lifestyle - caffeine, alcohol, stress, poor sleep → limit intake, therapy, sleep hygiene
-- Medications - steroids, antihistamines, pseudoephedrine, albuterol → avoid if able
-- Arrhythmia - ectopic beats, PAC/PVC, Afib, SVT, VT, heart block, Vfib → EKG, holter
-- Structural - CHF, valve insufficiency → Echo
-- Metabolic - hypoglycemia, thyrotoxicosis, hypoxia/hypercapnia, anemia → CBC, BMP, TSH
Exam: tachycardia, hypotension, S3, murmur, crackles, edema, JVP, pallor, cap refill
Plan
-- Labs: *** CBC, BMP, TSH
-- Cardiac: *** EKG, Holter/Event monitor, Echo
-- Lifestyle: Limit caffeine and alcohol, promote sleep hygiene
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Patient Guidance and Information
Working Up Palpitations
To better evaluate your palpitations, we recommend getting an EKG, event monitor, and an echocardiogram to see if there is an abnormal rhythm or structure of your heart.
We also have ordered lab work to assess if you are anemic, have low sugars, or have an overactive thyroid gland.
You should limit caffeine and alcohol intake. If you feel you have added stress in your life, you may benefit from speaking with a therapist, practicing yoga, or meditating.
If You Remember Nothing Else
Palpitations in the outpatient setting are most commonly psychosomatic, but you can’t miss an underlying cardiac etiology. Palpitations should always be taken very seriously in patients with underlying heart disease, those who have syncopized, and those whose palpitations last for longer than a few seconds at a time.
Clinical Pearls
- Etiology - psychosomatic (31%), Afib (16%), SVT (10%), medications/drugs (6%), systemic disease (4%), structural heart disease (3%), VTach (2%
Trials and Literature
Other Resources
Tweetorials
Video
