🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Palpitations

Medicine > Cardiovascular

Differential Diagnosis Schema 🧠

Cardiac Causes

  • Atrial fibrillation: Irregularly irregular pulse, often associated with palpitations, dizziness, and breathlessness.
  • Supraventricular tachycardia (SVT): Sudden onset and offset of rapid heart rate; may include chest discomfort and syncope.
  • Ventricular tachycardia: Life-threatening condition; presents with rapid, regular palpitations, often with syncope or hemodynamic instability.
  • Mitral valve prolapse: Palpitations, often associated with a mid-systolic click on auscultation and chest pain.
  • Bradyarrhythmias (e.g., heart block): Slow heart rate with intermittent palpitations; may present with dizziness or syncope.

Non-Cardiac Causes

  • Anxiety and panic disorders: Palpitations accompanied by anxiety, hyperventilation, and a sense of impending doom.
  • Thyrotoxicosis: Palpitations with symptoms of hyperthyroidism, including weight loss, tremor, and heat intolerance.
  • Pheochromocytoma: Episodic palpitations, hypertension, headache, and sweating; rare but important cause.
  • Hypoglycemia: Palpitations with sweating, tremors, and confusion, especially in diabetic patients.
  • Medications (e.g., beta-agonists, caffeine, cocaine): Palpitations due to stimulant effects or withdrawal.
  • Electrolyte imbalances: Palpitations with muscle weakness or cramps; often due to low potassium or magnesium levels.

Key Points in History 🥼

Onset and Duration

  • Sudden onset: Suggests arrhythmias like SVT or atrial fibrillation.
  • Gradual onset: More consistent with anxiety, thyrotoxicosis, or drug-induced causes.
  • Duration of palpitations: Short, episodic palpitations may indicate benign causes, while prolonged episodes can be more serious.
  • Frequency: Frequent palpitations may suggest an underlying arrhythmia; intermittent may be related to stress or lifestyle factors.

Character of Palpitations

  • Regular vs. irregular: Irregular palpitations often suggest atrial fibrillation; regular rapid palpitations may indicate SVT.
  • Pounding or fluttering: A pounding sensation may be due to anxiety, while fluttering could suggest atrial fibrillation.
  • Forceful beats: Can be associated with mitral valve prolapse or anxiety.
  • Associated symptoms: Palpitations with syncope, chest pain, or dyspnea are more likely to indicate a serious underlying cardiac cause.

Triggers and Relieving Factors

  • Exercise-induced: Palpitations triggered by exercise may indicate an underlying arrhythmia or structural heart disease.
  • Stress or anxiety: Palpitations associated with stressful events or anxiety suggest a non-cardiac cause.
  • Caffeine, alcohol, or drug use: Known triggers that can cause or exacerbate palpitations.
  • Position changes: Palpitations that occur when lying down may suggest atrial fibrillation or SVT.
  • Valsalva maneuver: May relieve SVT but worsen atrial fibrillation.

Background

  • Past medical history: Consider history of heart disease, thyroid disorders, or psychiatric conditions.
  • Medication history: Review for use of stimulants, beta-agonists, or withdrawal from medications such as beta-blockers.
  • Family history: Important for identifying genetic conditions like hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy.
  • Social history: Assess for lifestyle factors like smoking, alcohol use, and recreational drug use.
  • Occupational history: Stressful occupations or those involving shift work may contribute to palpitations.

Possible Investigations 🌡️

Electrocardiogram (ECG)

  • 12-lead ECG: Essential first-line investigation; identifies arrhythmias, ischemia, or structural heart disease.
  • Holter monitoring: Useful for detecting intermittent arrhythmias over 24-48 hours.
  • Event recorder: For patients with infrequent palpitations; allows recording during symptomatic episodes.
  • Exercise stress test: Assesses for exercise-induced arrhythmias and underlying ischemic heart disease.
  • Electrophysiological study: Considered in cases of recurrent SVT or unexplained syncope.

Laboratory Tests

  • Thyroid function tests: To assess for thyrotoxicosis in patients with palpitations and weight loss or tremor.
  • Electrolyte panel: Checks for imbalances like hypokalemia or hypomagnesemia that could precipitate arrhythmias.
  • Full blood count (FBC): Assesses for anemia, which can cause palpitations, particularly in patients with underlying cardiac disease.
  • Blood glucose levels: To identify hypoglycemia as a potential cause of palpitations.
  • Toxicology screen: Consider in cases where drug use is suspected.
  • BNP or NT-proBNP: Useful in assessing heart failure in patients with palpitations and dyspnea.

Imaging

  • Echocardiography: Assesses structural heart disease, including valvular disease and cardiomyopathies.
  • Chest X-ray: May be helpful in identifying cardiomegaly, pulmonary congestion, or other thoracic pathology.
  • Cardiac MRI: Considered in cases where detailed imaging of cardiac structures is required, particularly in suspected cardiomyopathy.
  • Coronary angiography: Used in patients with palpitations and high risk or evidence of ischemic heart disease.

No comments yet 😉

Leave a Reply

Cardiovascular