Palpitation: Difference between revisions
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==Etiology/cause== | ==Etiology/cause== | ||
In one [[cohort study]], causes were identified in 84%:<ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | In one [[cohort study]], causes were identified in 84%:<ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | ||
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==Evaluation== | ==Evaluation== | ||
The role of the [[medical history taking]] and [[physical examination]] have been systematically reviewed by the [[Rational Clinical Examination]].<ref name="pmid19920238">{{cite journal| author=Thavendiranathan P, Bagai A, Khoo C, Dorian P, Choudhry NK| title=Does This Patient With Palpitations Have a Cardiac Arrhythmia? | journal=JAMA | year= 2009 | volume= 302 | issue= 19 | pages= 2135-2143 | pmid=19920238 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19920238 | doi=10.1001/jama.2009.1673 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
===Medical history taking=== | ===Medical history taking=== | ||
Helpful findings in one cohort study were:<ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | Helpful findings in one cohort study were:<ref name="pmid8629647">{{cite journal| author=Weber BE, Kapoor WN| title=Evaluation and outcomes of patients with palpitations. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 138-48 | pmid=8629647 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8629647 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8629647 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
* History of heart disease [[cardiac arrhythmia]] | |||
* Duration more than 5 minutes suggested [[cardiac arrhythmia]] | * Duration more than 5 minutes suggested [[cardiac arrhythmia]] | ||
* Description of irregular heart [[rate]] suggested [[cardiac arrhythmia]] | * Description of irregular heart [[rate]] suggested [[cardiac arrhythmia]] | ||
* | * Increased number of symptoms suggested noncardiac causes in the univariate analysis. A similar observation (two or more prodromal symptoms) has been observed for determining the cause of [[syncope]]<ref name="pmid17397948">{{cite journal| author=Graf D, Schlaepfer J, Gollut E, van Melle G, Mischler C, Fromer M et al.| title=Predictive models of syncope causes in an outpatient clinic. | journal=Int J Cardiol | year= 2008 | volume= 123 | issue= 3 | pages= 249-56 | pmid=17397948 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17397948 | doi=10.1016/j.ijcard.2006.12.007 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> and psychiatric diagnoses<ref name="pmid7987511">{{cite journal| author=Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV et al.| title=Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. | journal=Arch Fam Med | year= 1994 | volume= 3 | issue= 9 | pages= 774-9 | pmid=7987511 | doi=10.1001/archfami.1994.01850220044011 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7987511 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>. | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17397948 | doi=10.1016/j.ijcard.2006.12.007 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> and psychiatric diagnoses<ref name="pmid7987511">{{cite journal| author=Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV et al.| title=Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. | journal=Arch Fam Med | year= 1994 | volume= 3 | issue= 9 | pages= 774-9 | pmid=7987511 | doi=10.1001/archfami.1994.01850220044011 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7987511 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>. | ||
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A heart rate < 60 or > 100 beats per minutes suggests [[cardiac arrhythmia]].<ref name="pmid17986627">{{cite journal| author=Hoefman E, Boer KR, van Weert HC, Reitsma JB, Koster RW, Bindels PJ| title=Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice. | journal=Fam Pract | year= 2007 | volume= 24 | issue= 6 | pages= 636-41 | pmid=17986627 | A heart rate < 60 or > 100 beats per minutes suggests [[cardiac arrhythmia]].<ref name="pmid17986627">{{cite journal| author=Hoefman E, Boer KR, van Weert HC, Reitsma JB, Koster RW, Bindels PJ| title=Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice. | journal=Fam Pract | year= 2007 | volume= 24 | issue= 6 | pages= 636-41 | pmid=17986627 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17986627 | doi=10.1093/fampra/cmm056 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17986627 | doi=10.1093/fampra/cmm056 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
==Prognosis== | |||
Symptoms may persist.<ref name="pmid7654112">{{cite journal| author=Barsky AJ, Cleary PD, Coeytaux RR, Ruskin JN| title=The clinical course of palpitations in medical outpatients. | journal=Arch Intern Med | year= 1995 | volume= 155 | issue= 16 | pages= 1782-8 | pmid=7654112 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&[email protected]&retmode=ref&cmd=prlinks&id=7654112 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 05:47, 23 August 2010
Etiology/cause
In one cohort study, causes were identified in 84%:[1]
- Cardiac arrhythmia in 43%
- Psychiatric, usually an anxiety disorder, in 31%
- Miscellaneous in 10%
Evaluation
The role of the medical history taking and physical examination have been systematically reviewed by the Rational Clinical Examination.[2]
Medical history taking
Helpful findings in one cohort study were:[1]
- History of heart disease cardiac arrhythmia
- Duration more than 5 minutes suggested cardiac arrhythmia
- Description of irregular heart rate suggested cardiac arrhythmia
- Increased number of symptoms suggested noncardiac causes in the univariate analysis. A similar observation (two or more prodromal symptoms) has been observed for determining the cause of syncope[3] and psychiatric diagnoses[4].
Palpitations followed by syncope suggest cardiac arrhythmia.[5]
Physical examination
A heart rate < 60 or > 100 beats per minutes suggests cardiac arrhythmia.[6]
Prognosis
Symptoms may persist.[7]
References
- ↑ 1.0 1.1 Weber BE, Kapoor WN (1996). "Evaluation and outcomes of patients with palpitations.". Am J Med 100 (2): 138-48. PMID 8629647.
- ↑ Thavendiranathan P, Bagai A, Khoo C, Dorian P, Choudhry NK (2009). "Does This Patient With Palpitations Have a Cardiac Arrhythmia?". JAMA 302 (19): 2135-2143. DOI:10.1001/jama.2009.1673. PMID 19920238. Research Blogging.
- ↑ Graf D, Schlaepfer J, Gollut E, van Melle G, Mischler C, Fromer M et al. (2008). "Predictive models of syncope causes in an outpatient clinic.". Int J Cardiol 123 (3): 249-56. DOI:10.1016/j.ijcard.2006.12.007. PMID 17397948. Research Blogging.
- ↑ Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV et al. (1994). "Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment.". Arch Fam Med 3 (9): 774-9. DOI:10.1001/archfami.1994.01850220044011. PMID 7987511. Research Blogging.
- ↑ Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T et al. (2008). "Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score.". Heart 94 (12): 1620-6. DOI:10.1136/hrt.2008.143123. PMID 18519550. Research Blogging. Review in: Evid Based Med. 2009 Jun;14(3):91
- ↑ Hoefman E, Boer KR, van Weert HC, Reitsma JB, Koster RW, Bindels PJ (2007). "Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice.". Fam Pract 24 (6): 636-41. DOI:10.1093/fampra/cmm056. PMID 17986627. Research Blogging.
- ↑ Barsky AJ, Cleary PD, Coeytaux RR, Ruskin JN (1995). "The clinical course of palpitations in medical outpatients.". Arch Intern Med 155 (16): 1782-8. PMID 7654112.