5. Palpitations Flashcards
conditions that can cause palpitations
Cardiovascular: Arrhythmia, cardiomyopathy, hypovolemia
Psychiatric: Anxiety, panic attacks
Medications: Caffeine, stimulants, theophylline, and albuterol use
Substances: Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine
Endocrinologic: Hyperthyroidism, pheochromocytoma, hypoglycemia
Hematologic: Anemia
Infectious: Febrile illness
What are some questions you can ask a patient presenting with palpitations?
dizziness or lightheadedness? chest pain or pressure? do you feel more hot or cold than others? any weight changes? do you drink caffeine?
Signs and Symptoms of Hyperthyroidism
Heat intolerance (92%)
Tachycardia (96%) due to increased adrenergic tone and heightened conduction
Fatigue (84%)
Weight loss (50%) due to increased calorigenesis and gut motility causing hyperdefecation and malabsorption.
Tremor (84%)
Increased sweating (96%)
Exertional dyspnea caused by O2 consumption, CO2 production, and respiratory muscle weakness
Which of the following can cause an enlarged thyroid, also known as goiter?
Lack of iodine B 74.3% Hypothyroidism(Hashimoto's) C 88.9% Hyperthyroidism(Graves) D 85.5% Nodules E 87.2% Cancer F 51.6% Pregnancy G 89.5% Thyroiditis
Clonus
A series of abnormal reflex movements of the foot induced by sudden dorsiflexion causing alternate contraction and relaxation of the gastrocnemius and soleus muscles.
What is the most common cause of hyperthyroidism in adults and children?
Toxic diffuse goiter (Graves’ disease)
(60-80%) of hyperthyroidism.
symptomatic relief of adrenergic symptoms in hyperthyroidism
Propranolol (beta blocker)
Radioactive iodine uptake (RAIU) test and scan
measures the amount and pattern of radioactive iodine taken up by the thyroid in the 24 hours following ingestion of a set dose. Normal RAIU uptake is 15-30% of the ingested dose.
High RAIU (>30%)
Graves' disease Multi-nodular goiter Toxic solitary nodule TSH-secreting pituitary tumor HCG secreting tumor
Low RAIU (
Sub-acute thyroiditis Silent thyroiditis Iodine induced Exogenous L-Thyroxine Struma ovarii Amiodarone
Thyroid peroxidase antibodies
present in 70-80% of Graves’ patients
When is a thyroid ultrasound is used ?
in the evaluation of thyroid nodules and thyroid enlargement but not hyperthyroidism
Radioactive iodine uptake and scan: diffuse increased uptake in the thyroid gland.
Interpret this result….
diffuse uptake in the thyroid gland indicates the entire gland is involved with this synthesis, not just nodular areas. These findings are consistent with Graves’ disease
Autoimmune disease in which thyrotropin receptor antibodies (also called thyroid stimulating immunoglobulins) are produced. These antibodies stimulate the thyroid gland to enlarge and to produce more thyroid hormone.
Graves Disease
what are the most common manifestations of Graves’ ophthalmopathy
eyelid retraction and exophthalmos.
