Palpitations

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of palpitations

Described as ‍racingirregularstrongflutteringskipped beats

Heart rate ‍ ‍not measured

Pattern ‍persistentintermittent

Onset of episodes is ‍gradualsudden, mainly ‍on exertionat restat night

Episodes last for ‍ ‍, recurs ‍ times per ‍

Worsening factors: ‍noneon exertionat rest

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍syncope

‍dizziness

‍fatigue

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg edema, ‍rightleftsymmetrical

‍anxiety

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍smoking

‍alcohol

‍drug use

‍caffeine

‍stress

‍lack of sleep

no history of: ‍arrhythmias, ‍hyperthyroidism, ‍panic disorder, ‍mitral valve prolapse

no use of: ‍thyroid medications, ‍stimulants, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Cardiac arrhythmia ‍likelysuspectedpossible

DDx: cardiac arrhythmias, atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, premature ventricular contractions, premature atrial contractions, anxiety, panic disorder, hyperthyroidism, electrolyte imbalances, dehydration, anemia, heart failure, mitral valve prolapse, cardiomyopathy, acute coronary syndrome, substance use (caffeine, alcohol, drugs), medication side effects, pulmonary embolism, fever, hypoglycemia, hyperventilation, pheochromocytoma





PLAN:

Investigations:

- ECG

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

- Holter monitor

- Echocardiogram

- Stress test

- Chest X-ray

Treatments:

- ‍Beta-blockers

- ‍Calcium channel blockers

- ‍Antiarrhythmics

- ‍Anticoagulants

- Stress management techniques

- Good sleep hygiene

- Healthy diet

- Regular exercise

- Avoidance of caffeine, stimulants, and alcohol

Further care:

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

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

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