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Overview / Goals

Overview / Goals. Define Statistics / Epidemiology History Exam Differential Dx Tests Put It All Together Sample Cases. Definition. sensations of a rapid or irregular heart beat. Differential Diagnosis of Palpitations. Arrhythmias Psychiatric causes Drugs and medications

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Overview / Goals

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  1. Overview / Goals • Define • Statistics / Epidemiology • History • Exam • Differential Dx • Tests • Put It All Together • Sample Cases

  2. Definition sensations of a rapid or irregular heartbeat

  3. Differential Diagnosis of Palpitations Arrhythmias Psychiatric causes Drugs and medications Nonarrhythmic cardiac causes Extracardiac causes

  4. Differential Diagnosis of Palpitations/ Drugs and medications Alcohol, Caffeine beta agonists, phenothiazine,theophylline, isotretinoin, digoxin Cocaine Tobacco

  5. Dietary Supplement Causing Palpitation Chocolate Ephedra/Diet pills Ginseng Bitter Orange Valerian Hawthorn

  6. Differential Diagnosis of Palpitations/ Arrhythmias Atrial fibrillation/flutter Bradycardia caused by advanced AV block or sinus node dysfunction Bradycardia-tachycardia syndrome(sick sinus syndrome) Multifocal atrial tachycardia Premature supraventricularor ventricular contractions Sinus tachycardia Supraventricular tachycardia Ventricular tachycardia Wolff-Parkinson-White syndrome

  7. Differential Diagnosis of Palpitations/ Nonarrhythmic cardiac causes Atrial or ventricular septal defect Cardiomyopathy Congenital heart disease Congestive heart failure Mitral valve prolapse Pacemaker-mediated tachycardia Pericarditis Valvular disease (e.g., aortic insufficiency,stenosis)

  8. Differential Diagnosis of Palpitations /Extracardiac causes Anemia, Electrolyte imbalance Fever Hyperthyroidism Hypoglycemia Hypovolemia Pheochromocytoma Vasovagal syndrome

  9. History/PE of Palpitation Description : Fluttering,pounding, or uncomfortable sensation in thechest or neck, or simply an increased awarenessof the heartbeat Knowing the circumstances,precipitating factors, and associated symptoms

  10. Exam • General Appearance? • Vitals: Pulse, BP, febrile or afebrile?, tachypneic? • Neck: JVP?, bruits?, carotid exam?, thyroid palpable and normal? • Pulmonary: Clear, rales or wheezing? • Cardiovascular: Apical pulse – regular, irregular, mostly regular with some ectopy?, normal heart sounds?, murmurs?, gallups?, rub?, PMI location? • Abdomen: Masses?, bruits? • Extremities: Edema – pitting or nonpitting? • …

  11. Differential Diagnoses • Arrhythmia (tachy / brady / SV / ventricular) • Heart Blocks (higher grade) • PVC’s / PAC’s • Sinus Tachycardia • Valvular Disease (usually arrythmias) • Structural Heart Disease (Ex.) HCM) • Anxiety • Depression • Hypoglycemia • Thyrotixicosis • Fever • Illicit Drugs • Prescribed Medications • Pheochromocytoma • …

  12. Diagnostic Implications • Overall: -84% of cases received a diagnosis 43% - Cardiac 31% - Psychiatric 10% - “Other” (Medications, drugs, etc…) -16%  No diagnosis found • ER or ambulatory setting? (differences p < 0.002)

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