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APPROACH TO PALPITATIONS, RED FLAGS IN HISTORY, RED FLAGS IN EXAMINATION,…

- - - - Anxiety : Accompamied by intense fear or worry. Most common non-cardiac cause.. Younger patient, may have disability, hypohondria like behaviour or somatization disorder.
      - Panic Attacks: Accompanied by very fast heart rate and sweating
      - Stress Fight and Flight mode
      - Depression: Accompanied by changes in sleep and appetite and anhedonia
    - - Strenuous exercise
      - Stimulants: Caffeine, Nicotine,Cocaine and Amphetamines, Cold and Cough medications (contain pseudoephedrine). look for Sx like Pupillary dilation, sweating, aberrant behaviour, dry mouth.
      - Hormonal Changes: Menstruation, Pregnancy, Menopause
    - - Anemia: History of fatigue, weakness, dizziness. Look for pallor and compensatory tachycardia. CBC: low Hb and HCT
      - Electrolyte imbalance : Hypo/Hyper kalemia, Hypocalcemia, Hypomagnesemia. Associated muscle cramps or weakness, numbness or tingling, History of excessive diuretics, kidney disease, Dehydration, GI loses like vomiting and diarrhea
      - Fever and Infections: Associated onset with fever, chills, bodyaches, Elevated temperature and signs of infection with elevated WBC
      - Hypoglycemia: Associated with sweating, dizziness, irritability and hunger. Patient may be known to be diabetic or fasting.
      - Adrenal Gland disorders: Pheochromocytoma: episodic severe headache, anxiety, palpitations,and hypertension. Diagnosed with elevated urinary or plasma catecholamines
      - Pulmonary Embolism: Associated chest pain and dyspnea with or without syncope. May have DVT legs, immobility or other hypercoagulable states. Diagnosed with CT Angiography, Elevated D Dimer
      - Dehydration: Associated with thirst, dry mouth, reduced urine output, lightheadedness, fatigue. History of heat exposure, Vomiting or Diarrhea. Examination reveals dry mucus membranes, tachycardia and low blood pressure
      - Medications: Stimulants, Decongestants, Thyroid hormone replacement, heart medications like beta agonist. Diagnosed by history of drug use
      - Thyroid Disorders: Hyperthyroidism, History of weight loss, heat intolerance, sweating, tremors. Examination may reveal enlarged thyroid with bulging eyes and fine tremors. Diagnosed with decreased TSH, and high T3 and T4.
    - - Anomalies in the functioning and/or programming of pacemakers and ICDs
      - Hypertrophic cardiomyopathy
      - Cardiomegaly and/or heart failure of various etiologies
      - Congenital heart diseases with significant shunt
      - Valvular: Most common is Mitral valve prolapse. Severe mitral regurgitation, Severe aortic regurgitation, Mechanical prosthetic valves
      - Cardiac arrhythmias: SVT, Extrasystoles, Tachycardia, AV blocks, Severe sinus bradycardia
      - Structural heart diseases