9-palpitations

Question 1

differential for Palpitations in a 50-Year-Old Woman

Answer 1

. Dysrhythmia
B. Valvular heart disease

D. Hyperthyroidism (or over-replacement)

F. Anxiety / panic disorder
G. Coronary heart disease (CHD)
H. Vasomotor symptoms of climacteric
I. Anemia

K. Prescription or illicit drug use

Question 2

midsystolic click with a holosystolic murmur would suggest

Answer 2

mitral valve prolapse

Question 3

the most common structural heart abnormality presenting with palpitations.

Answer 3

mitral valve prolapse

Question 4

A harsh crescendo-decrescendo that radiates into the carotid arteries would suggest

Answer 4

aortic stenosis

Question 5

Evaluation of Palpitations

Answer 5

EKG- only if current palpitations

• holter monitor
• Loop recorders

echo- rule out valvular and other structural defects.

CBC-anemia

TSH - hyperthyroidism.

urine drug screen

Question 6

Holter monitor

Answer 6

In order to increase the chances of capturing a dysrhythmia, the Holter monitor is a portable electrocardiograph machine that allows readings to be made over a 24 to 48-hour period, while the patient is performing the usual activities of daily living at home or at work.

Question 7

Loop recorders

Answer 7

increase the diagnostic yield with regard to detecting dysrhythmias

more cost effective.

monitor heart activity for weeks to months,

Question 8

Pain Characteristics That Decrease the Likelihood of ACS

Answer 8

pleuritic- worsened by respiration and lying down

pulsating

positional

reproduced by palpation- musculoskeletal

stabbing

Question 9

causes of pleuritic chest pain

Answer 9

pulmonary embolism, 
pneumothorax, 
viral or idiopathic pleurisy, 
pneumonia, 
pleuropericarditis.

Question 10

An exercise stress test is useful if

Answer 10

if the pretest probability of the disease is high with 3 significant risk factors.

False positives increase if the pretest probability is low

if diagnosis uncertain

Question 11

The USPSTF recommends initiating aspirin therapy in men what age and in woman what age and to prevent what in each group?

Answer 11

men- age 45 to 79 years - prevent MI

women- age 55 to 79 - prevent ischemic stroke