Differential Diagnosis
ADHD and rescue inhalers for asthma
30 y/o female comes in with palpitations, what is your initial diagnostic evaluation?
EKG and labs (CBC, CMP, thyroid, tox screen)
Atrial fibrillation
Beta blocker or nondihydropyridine calcium channel blockers
Top 2 etiologies of palpitations
Cardiac 43%, psychosomatic 31%
57 y/o marathon runner with PMH of PAD and CAD noticed palpitations while running the past 2 months. Normal EKG, TTE.
Stress test
Reassurance, yoga, cognitive behavior therapy, psychotropic mood stabilizers
Patient presents with palpitations and sensation of bugs crawling on skin. HR is 160, BP 160/100
Drug induced
John Doe is a 36 y/o M, no significant PMH, presents with intermittent palpitations for 2 weeks. Describes as fluttering in his chest, lasting 5-10 min, 3-4 times a week. Endorses 1 syncopal episode, denies chest pain. Vitals stable. EKG, normal sinus.
Holter monitor and labs (CBC, CMP, TSH, tox.)
Supra ventricular tachycardia
Vagal maneuver, adenosine, or electrical cardioversion
Top 3 red flags
hemodynamic instability, signs of MI, loss of consciousness
67 y/o F hx HFrEF with normal EKG done today
Trans thoracic Echo
Performance anxiety
Beta-blocker (Propranolol)
Adam is 29 y/o M, no PMH, presents with 1 month episodic palpitations. Describes as sudden, rapid, pounding heart beat lasting 10-20 min. Occurring spontaneously or with exertion at work. ROS: (+) light headedness, anxiety, weight loss (-) syncope, diaphoresis. List 4 systems to consider.
Endocrine (hyperthyroidism)
Cardiac (PSVT, A. Fib, WPW)
Toxicologic (stimulant use)
Hematologic (anemia)
Psychiatric (anxiety, panic disorder)
60 y/o female comes in with new onset palpitations that started this morning. You do an EKG that has no P or T waves, QRS complexes are broad (greater than 120ms) with rate of 192 bpm.
Call 911.
Cocaine intoxication
Benzos (diazepam)