Palpitation medical therapy: Difference between revisions

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{{Palpitation}}
{{Palpitation}}
{{CMG}}{{AE}}{{Akash}}{{CZ}}
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==Medical Therapy==
Treating heart palpitations depends greatly on the nature of the problem. In many patients, excessive caffeine intake triggers heart palpitations. In this case, treatment simply requires [[caffeine]] intake reduction. If it's been determined that caffeine is not the cause, another dietary consideration is too little magnesium, particularly in pre-menopausal women.  A supplement of equal dosages of magnesium and calcium may be helpful in eliminating palpitations. For severe cases, medication is often prescribed.
 
A variety of medications manipulate heart rhythm, which can be used to prevent palpitations. If severe palpitations occur, a [[beta blocker|beta-blocking drug]] is commonly prescribed. These block the effect of [[adrenaline]] on the heart, and are also used for the treatment of [[Angina pectoris|angina]] and high blood pressure. However, they can cause [[drowsiness]], sleep disturbance, [[depression]], [[impotence]], and can aggravate [[asthma]]. Other anti-arrhythmic drugs can be employed if [[beta blocker]]s are not appropriate.
 
If heart palpitations become severe, anti arrhythmic medication can be injected intravenously. If this treatment fails, [[cardioversion]] may be required. [[Cardioversion]] is usually performed under a short [[general anesthesia]], and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue.
 
For some patients, often those with specific underlying problems found in [[ECG]] tests, an electrophysiological study may be advised. This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the [[ECG]] from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i.e. if an electrical "short responds circuit" is shown to have an abnormal rhythm, then a special wire can be used to cut the "short circuit" by placing a small burn at the site. This is known as "[[radiofrequency ablation]]" and is curative in the majority of patients with this condition.
 
[[Atrial fibrillation]] has been discussed in a separate article. Differential Diagnosis of Palpitation
 
Treatment may include medication to control heart rate, or [[cardioversion]] to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, [[ablation]] of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of [[stroke]].
 
Also, palpitations are associated with an increased risk of blackouts and even premature death. Generally speaking, serious [[arrhythmia]]s occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.
 
Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]]. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].  
*The treatment strategy for [[patients]] presenting with [[palpitation]]s is directed towards treating the underlying [[cause]].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which [[patients]] can be discharged with the advice to follow up with a [[cardiologist]] and which [[patients]] require further workup.
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*[[Patients]] with no positive findings in their initial [[physical examination]] and [[12 lead ECG]] may be discharged with the advice to follow up with a [[cardiologist]]. <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613787 | doi= | pmc= | url= }} </ref>
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*[[Patient]]s with documented [[arrythmias]] or worrying symptoms such as [[presyncope]], [[syncope]], [[chest pain]], [[dyspnea]] or [[hemodynamic instability]] require further treatment.
===Disease Name===
*To elucidate the treatment of every underlying cause is beyond the scope of this chapter.
 
*[[Arrythmias]] may be treated with [[antiarrhythmics]] or [[invasive electrophysiologic management]]. <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>
* '''1 Stage 1 - Name of stage'''
**[[Premature ventricular contractions]] may be treated with [[beta blockers]], [[amiodarone]] or may be left alone if it is an isolated incident and the [[heart]] is structurally normal.
** 1.1 '''Specific Organ system involved 1'''
**In general, [[ventricular and atrial ectopics]] are commonly [[benign]] and reassurance along with withdrawal of [[precipitants]] (caffeine, alcohol) is the best treatment in such cases.<ref>{{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}}</ref>
*** 1.1.1 '''Adult'''
*The treatment of [[atrial fibrillation]] and [[atrial flutter]] involves [[rate control]], [[rhythm control]] and [[risk stratification]] for systemic [[anticoagulation]].
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**[[Paroxysmal supraventricular tachycardias]] may be treated with [[vagal maneuvers]], [[antiarrhythmics]] such as [[cardioselective beta blockers]], [[adenosine]] or [[non dihydropyridine calcium channel blockers]]. [[Ablation]] and [[synchronized cardioversion]] are reserved for [[haemodynamically unstable]] patients.
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**Sustained [[ventricular tachycardias]] with high risk features like an [[ejection fraction]] < 40% , [[family history]] of [[sudden cardiac death]] or a [[past history]] of [[structural heart disease]] may be referred for an [[electrophysiology study]] or [[implantable cardioverter defibrillator placement]].
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**Depending on the degree of [[heart block]], treatment may include reassurance, [[antiarrhythmics]] or [[temporary/permanent pacing]].
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*[[Structural heart disease]] such as [[hypertrophic cardiomyopathy]], [[severe valvular heart disease]] and [[congenital heart defects]] may be treated [[surgically]].
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*[[Antidotes]], [[behavioral therapy]] and cessation of [[drug]] intake would be the treatment strategy employed for [[palpitations]] secondary to [[substance abuse]].
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Endocrinology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
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Latest revision as of 19:58, 21 January 2021

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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

The treatment strategy for patients presenting with palpitations is directed towards treating the underlying cause. A physician needs to follow a standardized approach (which varies from institution to institution) in order to decide which patients can be discharged with the advice to follow up with a cardiologist and which patients require further workup.

Medical Therapy

References

  1. ↑ "StatPearls". 2020. PMID 28613787.
  2. ↑ name="pmid15742913">Abbott AV (2005). "Diagnostic approach to palpitations". Am Fam Physician. 71 (4): 743–50. PMID 15742913.
  3. ↑ "Palpitations - an overview | ScienceDirect Topics".
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