Palpitation physical examination: Difference between revisions

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[[Palpitations]] are typically a [[transient]] [[symptoms]]. Patients may or may not be in [[physical distress]] and may even present with [[altered mental status]] secondary to [[substance abuse]]. During a [[physical examination]] one must look for [[signs]] and [[symptoms]] of [[hyperthyroidism]], [[hypothyroidism]], [[congestive heart failure]], [[rhythm disturbances]] and [[structural heart disease]].
[[Palpitations]] are typically a [[transient]] [[symptoms]]. Patients may or may not be in [[physical distress]] and may even present with [[altered mental status]] secondary to [[substance abuse]]. During a [[physical examination]] one must look for [[signs]] and [[symptoms]] of [[hyperthyroidism]], [[hypothyroidism]], [[congestive heart failure]], [[rhythm disturbances]] and [[structural heart disease]].


==Physical Examination==
==Physical Examination <ref name="pmid10458728">{{cite journal| author=Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A | display-authors=etal| title=ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). | journal=Circulation | year= 1999 | volume= 100 | issue= 8 | pages= 886-93 | pmid=10458728 | doi=10.1161/01.cir.100.8.886 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10458728  }} </ref> <ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | doi=10.1016/s0002-9343(97)89451-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629647  }} </ref>  <ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | doi=10.1016/s0002-9343(97)89451-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629647  }} </ref> <ref name="pmid29995805">{{cite journal| author=Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L | display-authors=etal| title=Benefits of an early management of palpitations. | journal=Medicine (Baltimore) | year= 2018 | volume= 97 | issue= 28 | pages= e11466 | pmid=29995805 | doi=10.1097/MD.0000000000011466 | pmc=6076186 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29995805  }} </ref> <ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29995805">{{cite journal| author=Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L | display-authors=etal| title=Benefits of an early management of palpitations. | journal=Medicine (Baltimore) | year= 2018 | volume= 97 | issue= 28 | pages= e11466 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29995805 | doi=10.1097/MD.0000000000011466 | pmc=6076186 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29995805  }} </ref> <ref name="pmid9426932">{{cite journal| author=Fraser S, Evans MF| title=Diagnosis and prognosis of patients with palpitations. | journal=Can Fam Physician | year= 1997 | volume= 43 | issue=  | pages= 2131-2 | pmid=9426932 | doi= | pmc=2255099 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9426932  }} </ref>==




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=== Vital Signs ===
=== Vital Signs ===


* [[Tachycardia]] with [[regular pulse]] or [[irregularly irregular pulse]]
* [[Tachycardia]] with [[regular pulse]] or [[irregularly irregular pulse]] {{cite web |url=https://www1.racgp.org.au/ajgp/2019/april/approach-to-palpitations/ |title=RACGP - Approach to palpitations |format= |work= |accessdate=}} {{cite web |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/palpitations |title=Palpitations - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}} {{cite web |url=https://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/palpitations |title=Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}} {{cite web |url=https://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/palpitations |title=Palpitations - Cardiovascular Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}}
* An [[irregular pulse]] may indicate [[atrial fibrillation]] or [[atrial flutter]].
* An [[irregular pulse]] may indicate [[atrial fibrillation]] or [[atrial flutter]].
* A [[regular pulse]] may indicate [[sinus tachycardia]] or [[paroxysmal supraventricular tachycardia]].  
* A [[regular pulse]] may indicate [[sinus tachycardia]] or [[paroxysmal supraventricular tachycardia]].  
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* [[Fine/coarse bibasilar]] [[crackles]] upon [[auscultation]] – [[Congestive heart failure]]  
* [[Fine/coarse bibasilar]] [[crackles]] upon [[auscultation]] – [[Congestive heart failure]]  


=== Heart ===
=== Heart <ref name="pmid21766757">{{cite journal| author=Wexler RK, Pleister A, Raman S| title=Outpatient approach to palpitations. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 1 | pages= 63-9 | pmid=21766757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21766757  }} </ref><ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid28613787">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28613787 | doi= | pmc= | url= }} </ref> <ref name="pmid29431371">{{cite journal| author=Wexler RK, Pleister A, Raman SV| title=Palpitations: Evaluation in the Primary Care Setting. | journal=Am Fam Physician | year= 2017 | volume= 96 | issue= 12 | pages= 784-789 | pmid=29431371 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29431371  }} </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>===


* Displaced [[point of  maximal impulse]] (PMI) suggestive of [[left ventricular hypertrophy]] or  [[cardiomegaly]].  
* Displaced [[point of  maximal impulse]] (PMI) suggestive of [[left ventricular hypertrophy]] or  [[cardiomegaly]].  
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* Back examination of patients with [[palpitations]] is usually normal.
* Back examination of patients with [[palpitations]] is usually normal.


=== Genitourinary ===
=== Genitourinary ===


* [[Genitourinary examination]] of patients with [[palpitations]] is usually normal.
* [[Genitourinary examination]] of patients with [[palpitations]] is usually normal.
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=== [[Neuromuscular]] ===
=== [[Neuromuscular]] ===


* Patient is usually [[oriented]] to persons, place, and time
* Patient is usually [[oriented]] to persons, place, and time  
* [[Altered mental status]] – [[Myxedema madness]], [[alcohol]] consumption  
* [[Altered mental status]] – [[Myxedema madness]], [[alcohol]] consumption  
* [[Hyperreflexia]] –  [[Hyperthyroidism]]
* [[Hyperreflexia]] –  [[Hyperthyroidism]] {{cite web |url=https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.566760 |title=Palpitations &#124; Circulation |format= |work= |accessdate=}} {{cite web |url=https://doi.org/10.1016/j.amjmed.2010.01.012 |title=Redirecting |format= |work= |accessdate=}} {{cite web |url=+https://doi.org/10.1002/joa3.12358 |title=Isolated palpitations and ventricular pre‐excitation - Arias - 2020 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}} {{cite web |url=https://www.aafp.org/afp/2017/1215/p784.html |title=Palpitations: Evaluation in the Primary Care Setting - American Family Physician |format= |work= |accessdate=}}
* [[Hyporeflexia]] –  [[Hypothyroidism]]  
* [[Hyporeflexia]] –  [[Hypothyroidism]]  
* [[Proximal/distal muscle weakness]] [[unilaterally]]/[[bilaterally]] – [[Hypothyroidism]]  
* [[Proximal/distal muscle weakness]] [[unilaterally]]/[[bilaterally]] – [[Hypothyroidism]]  
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
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Latest revision as of 17:57, 31 January 2021

Palpitation Microchapters

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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

Palpitations are typically a transient symptoms. Patients may or may not be in physical distress and may even present with altered mental status secondary to substance abuse. During a physical examination one must look for signs and symptoms of hyperthyroidism, hypothyroidism, congestive heart failure, rhythm disturbances and structural heart disease.

Physical Examination [1] [2] [2] [3] [4] [5]

Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural heart disease, substance abuse or psychiatric disorders.

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Heart [6][7] [7] [7] [8] [9]

Abdomen

Back

  • Back examination of patients with palpitations is usually normal.

Genitourinary

Neuromuscular

Extremities

References

  1. Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A; et al. (1999). "ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography)". Circulation. 100 (8): 886–93. doi:10.1161/01.cir.100.8.886. PMID 10458728.
  2. 2.0 2.1 Weber BE, Kapoor WN (1996). "Evaluation and outcomes of patients with palpitations". Am J Med. 100 (2): 138–48. doi:10.1016/s0002-9343(97)89451-x. PMID 8629647.
  3. Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L; et al. (2018). "Benefits of an early management of palpitations". Medicine (Baltimore). 97 (28): e11466. doi:10.1097/MD.0000000000011466. PMC 6076186. PMID 29995805.
  4. Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L; et al. (2018). "Benefits of an early management of palpitations". Medicine (Baltimore). 97 (28): e11466. doi:10.1097/MD.0000000000011466. PMC 6076186. PMID https://www.ncbi.nlm.nih.gov/pubmed/29995805 Check |pmid= value (help).
  5. Fraser S, Evans MF (1997). "Diagnosis and prognosis of patients with palpitations". Can Fam Physician. 43: 2131–2. PMC 2255099. PMID 9426932.
  6. Wexler RK, Pleister A, Raman S (2011). "Outpatient approach to palpitations". Am Fam Physician. 84 (1): 63–9. PMID 21766757.
  7. 7.0 7.1 7.2 "StatPearls". 2020. PMID 28613787.
  8. Wexler RK, Pleister A, Raman SV (2017). "Palpitations: Evaluation in the Primary Care Setting". Am Fam Physician. 96 (12): 784–789. PMID 29431371.
  9. 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.