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Palpitations
From WikEM
Contents
Background
Red flags
- Cardiac disease
- Known contributory ECG abnormality
- Syncope/pre-syncope
- Exertional palpitations
- Hypotension or relative hypotension
- Heart failure symptoms
Clinical Features
- Sensation of rapid or irregular heart rate
Differential Diagnosis
Palpitations
- Arrhythmias:
- Atrial fibrillation
- Grouped beats on ECG (commonly misdx as A-fib)
- Atrial bigeminy and trigeminy
- Mobitz I or Mobitz II
- Atrial flutter
- SVT
- Ventricular Tachycardia
- Sick sinus syndrome
- Multifocal atrial tachycardia
- PVCs
- Wolff–Parkinson–White syndrome (WPW)
- Sinus node dysfunction
- AV Block
- Lown-Ganong-Levine Syndrome
- Accelerated idioventricular rhythm
- Non-arrhythmic cardiac causes:
- Cardiomyopathy
- CHF
- Mitral valve prolapse
- Congenital heart disease
- Pericarditis
- Valvular disease
- Pacemaker malfunction
- Acute MI
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Meds (i.e. digitalis, theophylline)
- Street drugs (i.e. cocaine)
- Tobacco
- Misc
Evaluation
Work-Up
Evaluation
- Thyroid exam
- Careful cardiac exam for murmurs
- Consider cardiac monitoring if perisistent
Management
- Etiology specific
Disposition
- Etiology specific
