Palpitation diagnostic study of choice

Revision as of 11:25, 6 August 2020 by Akash Daswaney (talk | contribs)
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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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