Palpitations

Question 1

Name all questions in presenting complaint? (9)

Answer 1

• “What do you mean by palpitations?”
• “Can you tap out the rate and rhythm of the palpitations?”
• “Did they come on suddenly? How long do they last?”
• “Is there anything in particular that sets the palpitations off?”
• “Is there anything you can do to stop the palpitations (e.g. holding breath or coughing)?”
• “Have you had any chest pain, fainting or breathlessness?”
• “Have you had any history of cardiac problems or hypertension?”
• “Have you noticed any weight loss, heat intolerance, increased stool frequency or irritability recently?”
• “Have you been feeling anxious recently or are you under any unusual stress?”

Question 2

First thing you should do?

Answer 2

Clarify what patient means by palpitations

Question 3

irregularly irregular beat suggests what?

Answer 3

AF

Question 4

Onset - difference between cardiac arrythmias and sinus tachycardia?

Answer 4

Cardiac arrythmias are sudden in onset wheras sinus tachy is usually insidious.

Question 5

What sorts of things to patients generally do to stop the palpitations?

Answer 5

• Coughing or swallowing sometimes terminates it

- Valsalva manoeuvre may terminate SVT

Question 6

Sudden onset, rapid palpitations followed by syncope suggests…?

Answer 6

VT

Question 7

Weight loss, heat intolerance, increased stool frequency and irritability suggest what

Answer 7

Thyrotoxicosis

Question 8

What should you ask about specifically in PMH?

Answer 8

Cardiac problems or hypertension. MI, valvular disease, cardiomyopathy, myocarditis and aberrant conduction pathways can cause arrythmias, which may present as palpitations.

Hypertensive patients at increased risk of developing AF.

Question 9

What can drinking cause?

Answer 9

Cardiomyopathy, which is associated with arrythmias