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Examination in palpitation
- 2. PALPITATION
ď˘ Definition:
âan awareness of ones heartbeat that is thought
inappropriate to the circumstances
- 3. GENERAL EXAMINATION
ď˘ PATIENT PANIC / NOT PANIC
ď˘ BUILT AND NOURISHMENT
ď˘ PALLOR
ď˘ ICTERUS
ď˘ CYANOSIS
ď˘ CLUBBING
ď˘ LYMPHADENOPATHY
ď˘ EDEMA
- 4. GENERAL EXAMINATION
ď˘ VITALS
PULSE-
RATE- tachycardia/bradycardia
Heart rate >120 beats/min or < 45 beats/min
while at rest
RHYTHM-
Regular-
occasional-SVT/VT
continuous-sinus tachycardia
high output states
Irregular- Atrial Fibrillation / Ectopics
sustained and irregularly irregular /chaotic -AF
- 5. GENERAL EXAMINATION
Intermittent and irregular/ felt as
missed beats- Ectopics
Volume-high/low
character-normal/abnormal
Condition of vessel wall-thickened/not
thickend
Radiofemoral delay-present/absent
peripheral pulsations-felt normal/not
- 8. SYSTEMIC EXAMINATION
ď˘ Palpation
ď˘ Palpation of the apcal impulse
ď˘ Left parasternal heave
ď˘ Sub xiphoid pulsations
ď˘ Palpation of the pulmonary arterial pulsation
ď˘ Thrills â palpable murmurs
- 11. Resting ECG
⢠Features to check
Sinus rhythm / arrhythmia
PR interval
QRS duration
QT Intervals
ST segment shape (LVH/Brugada)
T waves (? Cardiomyopathy)
- 12. KEY CLINICAL FINDINGS WITH PALPITATIONS AND
SUGGESTED DIAGNOSES
ď˘ Finding ď˘ Suggested diagnosis
ď˘ Single âskippedâ beats ď˘ Benign ectopy
ď˘ Feeling of being unable to ď˘ Ventricular premature
catch oneâs breath contractions
ď˘ Single pounding sensations ď˘ Ventricular premature
ď˘ Rapid, regular pounding in contractions
neck ď˘ Supraventricular
ď˘ Palpitations that are worse arrhythmias
at night ď˘ Benign ectopy or atrial
ď˘ Palpitations associated with fibrillation
emotional distress ď˘ Psychiatric etiology or
ď˘ Palpitations associated with catecholamine-sensitive
activity arrhythmia
ď˘ General anxiety ď˘ Coronary heart disease
ď˘ Panic attacks
- 13. KEY CLINICAL FINDINGS WITH PALPITATIONS AND
SUGGESTED DIAGNOSES
ď˘ Finding ď˘ Suggested diagnosis
ď˘ Medication or recreational drug use ď˘ Drug-induced palpitations
ď˘ Rapid palpitations with exercise ď˘ Supraventricular arrhythmia, atrial
fibrillation
ď˘ Positional palpitations ď˘ Atrioventricular nodal tachycardia,
pericarditis
ď˘ Heat intolerance, tremor, thyromegaly
ď˘ Hyperthyroidism
ď˘ Palpitations since childhood
ď˘ Rapid, irregular rhythm
ď˘ Supraventricular tachycardia
ď˘ Atrial fibrillation, tachycardia with
ď˘ Palpitations terminated by vagal variable block
maneuvers
ď˘ Supraventricular tachycardia
ď˘ Heart murmur
ď˘ Midsystolic click
ď˘ Heart valve disease
ď˘ Friction rub
ď˘ Mitral valve prolapse
ď˘ Pericarditis
- 15. DIFFERENTIAL DIAGNOSIS OF
PALPITATIONS
ď˘ ARRHYTHMIAS
ď˘ Atrial fibrillation/flutter
ď˘ Bradycardia caused by advanced arteriovenous block or
sinus node dysfunction
ď˘ Bradycardia-tachycardia syndrome(sick sinus
syndrome)
ď˘ Multifocal atrial tachycardia
ď˘ Premature supraventricular or ventricular contractions
ď˘ Sinus tachycardia or arrhythmia
ď˘ Supraventricular tachycardia
ď˘ Ventricular tachycardia
ď˘ Wolff-Parkinson-White syndrome
- 16. DIFFERENTIAL DIAGNOSIS OF
PALPITATIONS
ď˘ Psychiatric causes
ď˘ Anxiety disorder
ď˘ Panic attacks
ď˘ Drugs and medications
ď˘ Alcohol
ď˘ Caffeine
ď˘ Certain prescription and over-the-counter agents
(e.g., digitalis, phenothiazine, theophylline, beta
agonists)
ď˘ Street drugs (e.g., cocaine)
ď˘ Tobacco
- 17. DIFFERENTIAL DIAGNOSIS OF
PALPITATIONS
ď˘ Nonarrhythmic cardiac causes
ď˘ Atrial or ventricular septal defect
ď˘ Cardiomyopathy
ď˘ Congenital heart disease
ď˘ Congestive heart failure
ď˘ Mitral valve prolapsed
ď˘ Pacemaker-mediated tachycardia
ď˘ Pericarditis
ď˘ Valvular disease (e.g., aortic insufficiency, stenosis)
- 18. DIFFERENTIAL DIAGNOSIS OF
PALPITATIONS
ď˘ Extracardiac causes
ď˘ Anemia
ď˘ Electrolyte imbalance
ď˘ Fever
ď˘ Hyperthyroidism
ď˘ Hypoglycemia
ď˘ Hypovolemia
ď˘ Pheochromocytoma
ď˘ Pulmonary disease
ď˘ Vasovagal syndrome