Palpitations

Question 1

what are the red flag symptoms of palpitations and what do they indicate?

Answer 1

syncope
chest pain
palpitations during exertion
indicated haemodynamic compromise

SOB may indicate HF

Question 2

give some contributing factors to palpitations

Answer 2

caffeine
alcohol
illicit drugs e.g. cocaine, ecstasy
medications e.g. levothyroxine, beta agonists

Question 3

give some cardiac causes of palpitations

Answer 3

arrythmias e.g. AF, SVT, VT
ectopic beats
heart block
heart failure
valve incompetence
ACS

Question 4

give some non cardiac causes of palpitations

Answer 4

thyrotoxicosis
anaemia
pregnancy
hypoxia
mental healthy issues e.g. anxiety, panic disorder

Question 5

what are the key questions to ask in a history for palpitations?

Answer 5

rate - fast or slow. get pt to tap out rhythm
duration
frequency
circumstances in which they occur
associated symptoms
contributing factors
family history - structural heart abnormalities and sudden cardiac deaths

Question 6

how would you investigate palpitations?

Answer 6

bloods - FBC, U&E, TFTs to look for anaemia, electrolyte disturbance and thyrotoxicosis
12 lead ECG
Holtman 24hr monitor

may need ECHO or ETT

Question 7

what features would you look for on examination?

Answer 7

NB usually NAD as asymptomatic at the time

HR
BP
heart sounds - murmurs?
signs of HF
anaemia
signs of thyrotoxicosis

Question 8

what could cause a fast regular palpitation?

Answer 8

SVT
VT
anxiety/panic attack

Question 9

what could cause a fast irregular palpitation?

Answer 9

AF

atrial flutter

Question 10

what could cause a slow palpitation?

Answer 10

drugs e.g. beta blockers
pulsus bigeminus
ectopics