Palpitations

HISTORY:

Palpitations for ‍ ‍hoursdays

Type: ‍racingirregularstrongflutteringskipped beats

Heart rate: ‍ ‍not measured

Pattern: ‍constantintermittent

Onset: ‍gradualsudden, ‍on exertionat restat night

Episode duration: ‍ ‍secminhoursdaysweeksmonths

Worsening factors: ‍noneon exertionat rest

Alleviating factors: ‍none, ‍effectiveineffective

‍syncope

‍dizziness

‍fatigue

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg swelling

‍anxiety

‍headache

‍weight loss



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Cardiac arrhythmia ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ECG

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍TSH, ‍troponin, ‍d-dimers, ‍β-hCG

- Holter monitor

- Echocardiogram

- Stress test

- Chest X-ray

- ‍Beta-blockers

- ‍Calcium channel blockers

- ‍Antiarrhythmics

- ‍Anticoagulants

- Stress management techniques

- Good sleep hygiene

- Healthy diet

- Regular exercise

- Avoidance of caffeine, stimulants, and alcohol

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

- Return if palpitations worsen or if new symptoms develop such as chest pain or shortness of breath

- Go to ER if severe chest pain, severe shortness of breath, or fainting occurs