Palpitations Flashcards
Site
Usually not relevant but could be in the neck
Quality
Could you describe your heartbeat?
Is it a regular or irregular rhythm?
Could you tap it out?
Are the beats forceful or do they feel more like a flutter?
Severity
How fast are the heart beats?
What is it stopping you from doing?
Time course
How long have you had the palpitations for? Do the palpitations start suddenly? How long do the palpitations last? Are the palpitations getting worse? Has this ever happened before?
Context
When do palpitations occur?
Have there been any changes to your medication?
Are you stressed?
Do you get palpitations when you drink coffee?
Relieving factors
Is there anything that makes it better?
Aggravating factors
Is there anything that makes it worse?
Associated features
Do you notice anything else with the palpitations? Shortness of breath Chest pain Fatigue Dizziness and blackouts Thyroid problems
Differential diagnosis
Heart Failure– Past History, Family history of heart problems, Past MI, Shortness of Breath, Dizziness
Thyroid problems –Weight loss, enlarged neck, insomnia, anxiety, insensitivity to heat, (popping eyes), family history
Pulmonary Embolus – chest pain radiating to jaw, shoulder, back, dyspnoea, recent immobility, history of clotting disorder, syncope
Heart Attack – Chest Pain > 20 minutes, radiating to shoulder and jaw (left side), past history and family history of Cardiovascular Problems
Anaemia – fatigue, paleness
Social – context, stress, coffee, anxiety, exercise
What is particularly important in time course?
Sudden onset and offset is more likely to indicate significant disease.
What are some associated features?
Shortness of breath Chest pain Fatigue Dizziness and blackouts Thyroid problems (see below)
What are some aggravating factors/context that are worth asking specifically about?
Stress
Coffee
Exercise
