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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
*There is no single diagnostic study of choice for the diagnosis of palpitations, but palpitations can be diagnosed based on a through initial evaluation (a detailed history, physical examination and 12 lead ECG).
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*Following this, investigative modalities such as an echocardiography, electrophysiologic study, a different forms of ambulatory ECG monitoring and laboratory investigations such as a renal function test, thyroid function tests and serum drug levels may be employed.
 
*The following algorithm can be employed when approaching a patient presenting with palpitations. <ref name="pmid15742913">{{cite journal| author=Abbott AV| title=Diagnostic approach to palpitations. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 4 | pages= 743-50 | pmid=15742913 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15742913  }} </ref><ref name="pmid31256490">{{cite journal| author=McLellan AJ, Kalman JM| title=Approach to palpitations. | journal=Aust J Gen Pract | year= 2019 | volume= 48 | issue= 4 | pages= 204-209 | pmid=31256490 | doi=10.31128/AJGP-12-17-4436 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31256490  }} </ref><ref name="pmid21697315">{{cite journal| author=Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L | display-authors=etal| title=Management of patients with palpitations: a position paper from the European Heart Rhythm Association. | journal=Europace | year= 2011 | volume= 13 | issue= 7 | pages= 920-34 | pmid=21697315 | doi=10.1093/europace/eur130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21697315  }} </ref><ref name="pmid23177608">{{cite journal| author=Jamshed N, Dubin J, Eldadah Z| title=Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options. | journal=Clin Geriatr Med | year= 2013 | volume= 29 | issue= 1 | pages= 205-30 | pmid=23177608 | doi=10.1016/j.cger.2012.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177608  }} </ref>{{cite journal |vauthors=Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Khuchua TO, Sukhareva BS, Granström G, Linde A |title=Coronary vascular and myocardial responses to carotid body stimulation in the dog |journal=Am. J. Physiol. |volume=229 |issue=3 |pages=754–60 |date=September 1975 |pmid=2017 |doi=10.1152/ajplegacy.1975.229.3.754 |url=}}
OR
 
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


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{{familytree | | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | |}}
{{familytree | | | | | | | | B01 | | | | | | | | | | | | | | | | |B02| |B01=Hemodynamically stable|B02=Hemodynamically unstable}}
{{familytree | | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| | |}}
{{familytree | | | | | | | | C01| | | | | | | | | | | | | | | | |  C02| |C01=History, Physical examination and 12 Lead ECG|C02=Follow ACLS protocol}}
{{familytree | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | |}}
{{familytree | D01| | | | | D02| | | | | | | | | | | D03| | | | | | | | | |D01=Positive ECG Findings|D02=Systemic/pharmacological cause|D03=Cause not established}}
{{familytree | |!| | | | | ||!| | | | | | | | |,|-|-|-|^|-|-|-|.| | | |}}
{{familytree | |!| | | | | |F01| | | | | | | |F02 | | | | | | F03| | | | |F01=Appropriate laboratory investigations/cessation of causative drug|F02=Frequent/distressing Episodes|F03=Rare/well Tolerated Episodes}}
{{familytree | |!| | | | | ||!| | | | | | | |||!| | | | | | | |!| | |}}
{{familytree | |!| | | | | |H01| | | | | | | |H02 | | | | | | H03| | | | | |H01=Plan for definitive treatment|H02=Ambulatory EKG monitoring|H03=No further workup}}
{{familytree | |!| | | | | | | | | | | | | | | ||!| | | | | | | | | | | |}}
{{familytree | |!| | | | | | | | | | | | | | | |J01 | | | | | | | | | | | | |J01=Cardiology Referral}}
{{familytree | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | L01|-|-|-|-|-| L02|-|-|-|-|-|-| L03| | | | | | | | | | | | | | | |L01=Arrhythmia|L02=Structural Heart Disease|L03=Myocardial Ischemia}}
{{familytree | |!| | | | | | ||!| | | | | | || |!| | | | | | | | | | | |}}
{{familytree | N01| | | | | | N02 | | | | | | |N03| | | | | | | | | | | | | | |N01=Treat accordingly or plan for discharge if benign|N02=Perform echocardiography|N03= Urgent treatment}}
{{familytree | |!| | | | | | ||!| | | | | | | | | | | | | | | | | | | |}}
{{familytree | P01| | | | | | P02 | | | | | | | | | | | | | | | | | | | | | |P01=Cardiology referral|P02=Cardiology referral}}
{{familytree/end}}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 11:25, 6 August 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]

Overview

Diagnostic Study of Choice

  • There is no single diagnostic study of choice for the diagnosis of palpitations, but palpitations can be diagnosed based on a through initial evaluation (a detailed history, physical examination and 12 lead ECG).
  • Following this, investigative modalities such as an echocardiography, electrophysiologic study, a different forms of ambulatory ECG monitoring and laboratory investigations such as a renal function test, thyroid function tests and serum drug levels may be employed.
  • The following algorithm can be employed when approaching a patient presenting with palpitations. [1][2][3][4]Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Khuchua TO, Sukhareva BS, Granström G, Linde A (September 1975). "Coronary vascular and myocardial responses to carotid body stimulation in the dog". Am. J. Physiol. 229 (3): 754–60. doi:10.1152/ajplegacy.1975.229.3.754. PMID 2017.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palpitations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamically stable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamically unstable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History, Physical examination and 12 Lead ECG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow ACLS protocol
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive ECG Findings
 
 
 
 
Systemic/pharmacological cause
 
 
 
 
 
 
 
 
 
 
Cause not established
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appropriate laboratory investigations/cessation of causative drug
 
 
 
 
 
 
 
Frequent/distressing Episodes
 
 
 
 
 
Rare/well Tolerated Episodes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Plan for definitive treatment
 
 
 
 
 
 
 
Ambulatory EKG monitoring
 
 
 
 
 
No further workup
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiology Referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Arrhythmia
 
 
 
 
 
Structural Heart Disease
 
 
 
 
 
 
Myocardial Ischemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat accordingly or plan for discharge if benign
 
 
 
 
 
Perform echocardiography
 
 
 
 
 
 
Urgent treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiology referral
 
 
 
 
 
Cardiology referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Abbott AV (2005). "Diagnostic approach to palpitations". Am Fam Physician. 71 (4): 743–50. PMID 15742913.
  2. ↑ McLellan AJ, Kalman JM (2019). "Approach to palpitations". Aust J Gen Pract. 48 (4): 204–209. doi:10.31128/AJGP-12-17-4436. PMID 31256490.
  3. ↑ Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L; et al. (2011). "Management of patients with palpitations: a position paper from the European Heart Rhythm Association". Europace. 13 (7): 920–34. doi:10.1093/europace/eur130. PMID 21697315.
  4. ↑ Jamshed N, Dubin J, Eldadah Z (2013). "Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options". Clin Geriatr Med. 29 (1): 205–30. doi:10.1016/j.cger.2012.10.003. PMID 23177608.

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