Cardiovascular Medicine Book

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Palpitation

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  1. Definition
    1. Awareness of the heart beat
  2. Symptoms
    1. Pounding or fluttering sensation in the chest
    2. Sensation of skipping or missing a beat
    3. Sensation that heart is stopping or jumping
  3. Red Flag symptoms suggestive of serious cause
    1. Syncope
    2. Associated cardiopulmonary symptoms
  4. Screening suggestive of Panic Disorder
    1. Precaution: Panic may be comorbid with organic cause
    2. Have you experienced brief periods
      1. Overwhelming panic and
      2. Racing heart beat, Shortness of Breath, or Dizziness
  5. Differential Diagnosis
    1. Isolated single beats improved with Exercise
      1. Premature Atrial Contractions
      2. Premature Ventricular Contractions
    2. Slow Heart Rate with palpitations
      1. Atrioventricular Block
      2. Sinus node disease (e.g. Sick Sinus Syndrome)
    3. Rapid beats with sudden onset (Tachyarrhythmias)
      1. Sinus Tachycardia
      2. Paroxysmal Supraventricular Tachycardia (PSVT)
      3. Paroxysmal Atrial Fibrillation or Atrial Flutter
      4. Ventricular Tachycardia
    4. Intermittent episodes with gradual onset
      1. Caffeine (tea, coffee, soda, chocolate)
      2. Stimulants
        1. Cocaine
        2. Ephedra
      3. Other medications
        1. Theophylline
        2. Beta Agonists
        3. Digitalis
      4. Carbon Monoxide toxicity
      5. Tobacco products
      6. Panic Attack
      7. Pheochromocytoma (rare)
      8. Mitral Valve Prolapse
    5. Persistant palpitations at rest
      1. Anemia (worse with Exercise)
      2. Hyperthyroidism
      3. Hypertension
      4. Beriberi
      5. Fever
      6. Dehydration
      7. Anxiety Disorder
      8. Cardiomyopathy
      9. Pericarditis
      10. Valvular abnormality
        1. Aortic Regurgitation
        2. Mitral Regurgitation
        3. Large Ventricular Septal Defect
  6. Labs
    1. Thyroid Stimulating Hormone (TSH)
    2. Hemoglobin
    3. Consider additional tests when indicated
      1. Serum Potassium
      2. Serum Calcium
      3. Serum Magnesium
      4. Serum Glucose
      5. Digoxin level
  7. Diagnostic testing
    1. Electrocardiogram
      1. Prior Myocardial Infarction
      2. Left Ventricular Hypertrophy
      3. Right Ventricular Hypertrophy
      4. Atrial enlargement
      5. AV Block or short PR interval
      6. Prolonged QT Interval
      7. Wolff-Parkinson-White Syndrome
    2. Ambulatory monitoring
      1. Continuous EKG Monitor (Holter Monitor)
      2. Event Monitor
    3. Consider additional testing when indicated
      1. Exercise Stress Test if Exercise induced
      2. Echocardiogram
      3. Electrophysiologic Study if Syncope related
  8. Management
    1. Evaluate and treat specific causes
    2. General measures
      1. Exercise program (if evaluation negative)
      2. Eliminate caffeine, Alcohol, and Tobacco
      3. Maximize hydration
      4. Stress reduction
  9. References
    1. Braunwald (2001) Heart Disease, Saunders, p. 37-38
    2. Degowin (1987) Diagnostic Exam, MacMillan, p. 334
    3. Goroll (2000) Primary Care, Lippincott, p. 141-6

Palpitations (C0030252)

Definition (NCI)An unpleasant sensation of irregular and/or forceful beating of the heart.
ConceptsFinding (T033)
ICD9785.1
EnglishHEART THROBBING, PALPITATION, Palpitations, Palpitations Adverse Event
Spanishpalpitaciones
Parent ConceptsConduction disorder of the heart (C0264886), cardiac arrhythmia (C0003811), Cardiac Disorders, General, Functional and NEC (C0549515), Symptoms involving cardiovascular system (C0159049), Cardiovascular System Signs and Symptoms (C1332855), Adverse Event Associated with Cardiac Arrhythmia (C1560249), Palpitations (C0030252), [D]Cardiovascular system symptoms (C0476270), Finding related to awareness of heart beat (C1287709), Sensation related to thoracic organ (C1291043), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CST, DXP, ICD9CM, LCH, MTH, NCI, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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