Please enable JavaScript.
Coggle requires JavaScript to display documents.
Palpitations, Syncope, Presyncope - Coggle Diagram
Palpitations, Syncope, Presyncope
1. Palpitations
differential diagnosis
sinus tachycardia
triggers: anxiety, exertion, stimulants, fever, alcohol, hyperthyroid
Non-sinus Arrhythmias
ectopic beats: Premature ventricular contractions or premature atrial contractions
tachycardia: atrial, ventricular, AV nodal re-entry, Wolff Parkinson White
bradycardia: AV blocks, sick sinus syndrome, pauses
evaluation of palpitations
pulse exam
importance of checking rhythm and rate
regular: count 15 sec x 4 = beats per minute (60-100 is normal)
irregular pulse: count full 30-60 seconds
central pulses (carotid, brachial)
carotid: palpitations are related to aortic valve
brachial: most reliable measurement of heart rate; USE IN PTS WITH A-FIB OR IRREGULAR HEART BEATS
QTc
prolongation
risks: torsades de pointes, 65y+, female, heart disease, meds that cause QT prolongation, bradycardia, genetics
causes: ABCDEF
anti-Arrythmics; anti-Biotics; anti-psyChotics; anti-Depressants; anti-Emetics; anti-Fungals
QTc normal/borderline/prolonged ranges
borderline: 460-479F 450-469M
prolonged
: >480F >470M
normal: <460F <450M
patient hx
onset (sudden vs gradual)
provokers
quality (fast, slow, irregular)
relievers (Valsalva, positioning)
severity (impact on life)
timing (duration, frequency)
assoc sx (SOB, pericarditis, syncope)
pertinent negative: age, absence of risk factors (if pt is young with no risk factors, it is less likely to be cardiac related palpitations and probably related to stimulants/anxiety/exercise)
definition and description
common symptom that feels like pounding, racing, skipped beats, forceful, irregular; pt is aware of their heartbeat
2. Syncope, Presyncope, Lightheadedness
clinical spectrum
syncope --> pre syncope --> lightheadedness (most wide and common)
important to differentiate from "dizziness"
differential diagnosis
orthostatic hypotension
cardiac causes: arrhythmias, valvular disease, hypertrophic cardiomyopathy
vasovagal (common, situational) triggered by fear, blood, pain; benign ✅
neurologic/psychiatric
definitions
pre syncope: feeling faint and lightheaded, possible loss of consciousness
lightheadedness: less serious, may not involve hemodynamic compromise; NOT the same as dizziness
syncope: sudden, transient loss of consciousness due to low cerebral perfusion (fainting basically)
evaluation of syncope (same as presyncope and lightheadedness)
severity: injuries? medical attention needed?
assoc sx: palpitations, flushing, SOB, nausea, sweating
triggers: position change, meds, dehydration
pertinent negatives: incontinence, seizure-like, prolonged loss of consciousness, cheek biting
onset: childhood vs sudden
timing: how long does the LOC last and does anybody witness it
3. Orthostatic Hypotension
goals of management
improve sx and QofL, not necessarily normalize BP
common causes
dehydration, medications (cardiac meds or non-cardiac)
cardiac: diuretics, Beta blockers, alpha blockers, amlodipine, nitrates
non-cardiac: antidepressants, benzos, antipsych, opioids, trazodone
definition
drop in Systolic > 20, or Diastolic > 10 within 3 minutes of standing
clinical tip
treat the pt! not the numbers
asymptomatic BP drops don't need intervention