Friday, 28 February 2014

Palpitations

Palpitations are a difficult area to cover as there are so many potential ECG abnormalities, and so much detail you could go into about treating them. Luckily, EnlightenMe again comes to the rescue for the generic areas. We'll cover each common abnormality in a bit more detail eventually!

EnlightenMe:
http://www.enlightenme.org/knowledge-bank/cempaedia/palpitations
http://www.enlightenme.org/learning-zone/cardioversion-conundrum
http://www.enlightenme.org/the-learning-zone/node/10940

GoogleFOAM:
http://academiclifeinem.com/modern-em-case-4-palpitations/

Palpitations have an underlying cardiac cause in 43%, are due to anxiety in 31% and have no specific attributable cause in 16% of patients. Worryingly, they're more likely to have a "proper" cause if they occur at work, whilst sleeping, or in the presence of known cardiac disease!

Focused History:
Establish the presence of symptoms which may indicate an underlying cause:
    Chest pain (in the absence of or preceding palpitations)
    Tremor
    Sweating
    Abdominal pain
    Anxiety
    Heat intolerance
    Weight change
    Productive cough
    Depression
    Weakness
    Fatigue
    History of structural heart disease
    Family history of sudden cardiac death



Investigations
    Electrolyte measurement (potassium, calcium and magnesium)
    Glucose
    TFTs
    FBC
    
Management after rhythm or rate control
Admit if:
   At risk of life threatening arrhythmia e.g. those with a previously recorded episode of VT
   Adverse symptoms or signs during the palpitations.
   Implanted cardiac devices suspected of malfunction.
   Family history of sudden death (eg, Brugada Syndrome).
   Require admission for investigation or treatment of an underlying cause or illness
   No protocols for follow up
  

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