DOORWAY-PALPITATIONS Flashcards
PALPITATIONS-DIFFERENTIALS
Cardiac Arrhythmia, Caffeine, Fever, Anxiety/Panic Disorder, HypoGlycemia, Anemia, HyperThyroidism
RULE OUT CARDIAC ARRHYTHMIA
a. Have you noticed any chest pain? SOB? Racing of heart? Skipped beats? Sweating?
CARDIAC ARRHYTHMIA WORKUP
ECG
TEE
Event monitor
Holter monitor
24~hour urinary
catecholamine&
RULE OUT CAFFEINE
a. Do you consume caffeinated beverages? If yes, then ask how much?
RULE OUT ANXIETY/PANIC DISORDER
a. Is there any event associated with the racing of heart?
b. Does your breathing rate increase or feel shortness of breath during the episode?
c. Do you feel dizzy during the episode?
ANXIETY WORKUP
CBC
Electrolytes
TSH,FT4
RULE OUT HYPOGLYCEMIA
a. Do you have a Hx of High blood sugar level?
b. Have you skipped meals? Or changed any dose or medications recently?
HYPOGLYCEMIA WORKUP
Glucose
CBC
Electrolytes
TSH
ECG
24,hour urinary
catecholamines
5,HIAA
RULE OUT ANEMIA
a. Have you noticed any change of skin color?
b. Have you noticed SOB on exertion?
c. Have you noticed bleeding (excessive-for menses) from any site of the body?
d. Have you noticed any change in your stool color?
e. What does your diet consist of?
f. Do you have any craving for ice?
ANEMIA WORKUP
CBC
RULE OUT HYPERTHYROIDISM
a. Have you noticed racing of heart?
b. Have you noticed any skin changes?
c. Have you noticed any tremors/shaking of hands?
HYPERTHYROIDISM WORKUP
TSH,FT4
Thyroid ultrasonography: Can diagnose the etiology of hyperthyroidism (e.g., diffuse enlargement, solitary/multiple nodules, increased vascularity of the gland)
RULE OUT PHEOCHROMOCYTOMA
Do you have headache? Any sweating?
OTHER
Clinical presentation is related to fluctuating levels of excess epinephrine, norepinephrine, and dopamine.
Episodic hypertension (or persistent hypertension in some cases)
Paroxysmal
Throbbing headache
Diaphoresis
Heart palpitations and tachycardia
Pallor
Abdominal pain and nausea
Anxiety
Hypertensive crises can be triggered by palpation of the tumor on abdominal exam!
PHEOCHROMOCYTOMA
24,hour urinary catecholamines
PALPITATIONS WORKUP
CBC
Electrolytes
TSH,FT4
ECG
Echocardiography
Urine toxicology
24~hour urinary
catecholamines
Glucose
CBC
Electrolytes
TSH
ECG
24,hour urinary
catecholamines
5,HIAA
RULE OUT CARCINOID SYNDROME
Do you have diarrhea?
How is your diet?
How is your weight? Has it changed?
OTHER
Asymptomatic
Abdominal pain
Carcinoid syndrome
Diarrhea and abdominal cramps
Cutaneous flushing
Possible triggers: alcohol consumption, food intake, stress
In severe cases, may be accompanied by tachycardia and fluctuating blood pressure
Dyspnea, wheezing (asthma-like attacks)
Possible weight loss despite normal appetite
Carcinoid heart disease
Tricuspid insufficiency and/or pulmonary stenosis
Symptoms of right-sided heart failure
Possible pellagra (niacin deficiency)
Presents as a triad of dermatitis, diarrhea, and dementia.
CARCINOID SYNDROME WORKUP
Biochemistry tests should be performed first if a carcinoid tumor is suspected. Imaging tests are then used to localize and stage the tumor.
Biochemistry tests
↑ 5-hydroxyindoleacetic acid (5-HIAA) in 24-hour urine
↑ Serotonin serum levels
Imaging
CT scans of the abdomen and pelvis
Somatostatin-receptor scintigraphy (e.g., OctreoScan®)
MRI
Transabdominal ultrasound: although not part of the workup, sometimes detects a mass if routinely conducted
Biopsy
