Palpitations and tired patient Flashcards
Fatigue red flags
- recent onset fatigue in a previously well older patient
- fever
- weight loss
- unexplained lymphadenopathy
- other features of malignancy
- dyspnoea
- recent onset of progression of cardiorespiratory, gastroenterological, neurological or rheumatological symptoms
Alarming symptoms with heart palpitation presentation
Syncope or near syncope (V arrhythmias)
Angina (IHD)
2 ‘easy’ tests before formal tests for fatigue?
urine dipstick and finger prick blood tests
Investigations of heart palpitations?
- Physical examination
- ECG
Further:
- FBC
- Glucose
- TFT
- 24 hour ambulatory ECG halter monitoring
- If structural heart disease detected: echo, treadmill/stress test, cardiac catheterisation/MRI heart
Other
- Implantable loop recorder
- Electrophysiological test
Symptoms of SVT
- sudden onset and offset
- fast and regular, rater > 130bpm
- may be related to posture
Symptoms of VT
- sudden onset and offset
- fast and regular
- may be related with syncope
Define palpitations
awareness of the beating of the heart, usually with a change in heart rate, rhythm or contractility
Symptoms of extrasystoles/ventricular ectopics
- flopping, drop beats, jumps or skips
- pause following premature beat felt as cessation of heart beat
- 1st ventricular contraction succeeding the pause felt as an unusual forceful vigorous beat
Main categories of underlying diseases presenting with heart palpitations?
Metabolic disorders
High output states
Cardiac
Psychiatric
Medication
Catecholamine stress
Habits
Fatigue and 5 other symptoms which can help with differential diagnoses
1) limb weakness
2) sleepiness
3) breathlessness and exercise limitation
4) lack of energy
5) lack of motivation
Common causes of sinus tachycardias?
- anaemia
- thyrotoxicosis
- hypoglycaemia
Define:
1- recent lethargy
2- prolonged lethargy
3- chronic lethargy
1- < 1 month
2- > 1 month
3- > 6 months
Definition of lethargy
- inability to initiate activity
- decreased ability to maintain activity
- difficulty with concentration, memory or emotional stability
