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Palpitations - Coggle Diagram
Palpitations
Pharmacology
Rate control
Beta‑blockers
Bisoprolol
Metoprolol
Atenolol
↓ HR, ↓ sympathetic drive
Calcium channel blockers (non‑DHP)
Diltiazem
Verapamil
↓ AV node conduction
Rhythm control
Class Ic
Flecainide
Propafenone
Use in structurally normal hearts
Class III
Amiodarone
Sotalol
Prolong repolarisation
SVT‑specific
Adenosine
Rapid AV node block
Terminates AVNRT/AVRT
Beta‑blockers / CCBs
Prevent recurrence
AF‑specific
Rate control
Beta‑blockers
Diltiazem
Rhythm control
Flecainide
Amiodarone
Anticoagulation
DOACs (apixaban, rivaroxaban)
Warfarin (less common now)
Electrolyte correction
Potassium replacement
Correct hypokalaemia
Magnesium replacement
Correct hypomagnesaemia
Useful in ectopy & torsades
Thyroid‑related
Carbimazole / PTU
Treat thyrotoxicosis
Beta‑blockers
Symptom control
Anxiety‑related
SSRIs
Long‑term management
Short‑term
Propranolol (situational)
Frailty considerations
Lower doses
Avoid polypharmacy
Avoid QT‑prolonging drugs
Monitor renal function
Watch for hypotension
Aetiology
Cardiac
Arrhythmias
Structural heart disease
Valve disease
Systemic
Anaemia
Thyroid disease
Fever
Hypoglycaemia
Psychological
Anxiety
Panic attacks
Stress
Lifestyle
Caffeine
Alcohol
Nicotine
Recreational drugs
Medication‑related
Beta‑agonists
Antidepressants
Antipsychotics
Decongestants
Investigations
Bedside
Obs + NEWS2
ECG
Rhythm strip
Laboratory
FBC (anaemia)
U&Es (electrolytes)
TFTs (thyroid)
CRP (infection)
Glucose
Imaging
Echo (if structural disease suspected)
Monitoring
Holter (24–72h)
Event monitor
Wearable ECG (selected cases)
Frailty‑specific
Hydration status
Medication review
Management
Immediate
Treat underlying cause
Manage red flags
Stabilise haemodynamics
Arrhythmia‑specific
Rate control
Rhythm control
Vagal manoeuvres (SVT)
Antiarrhythmics
Systemic
Treat anaemia
Correct electrolytes
Manage thyroid disease
Treat infection
Lifestyle
Reduce caffeine
Reduce alcohol
Smoking cessation
Frailty
MDT input
Medication rationalisation
Hydration support
Safety‑netting
Pathophysiology
Electrical abnormalities
Ectopic beats
Re‑entry circuits
Conduction block
Rate abnormalities
Tachycardia
Bradycardia
Rhythm abnormalities
Irregular rhythm
Compensatory pauses
Autonomic imbalance
Sympathetic overactivity
Parasympathetic withdrawal
Risk factors
Cardiac
Hypertension
IHD
Heart failure
Previous arrhythmia
Systemic
Thyroid disease
Anaemia
Electrolyte imbalance
Lifestyle
High caffeine
Alcohol binges
Smoking
Frailty‑specific
Polypharmacy
Dehydration
Infection
Reduced physiological reserve
Red flags
Cardiac
Syncope / presyncope
Chest pain
Sustained tachycardia
Hypotension
Systemic
Severe breathlessness
Haemodynamic instability
Frailty
Acute confusion
Functional decline
Reduced oral intake
History
Known structural heart disease
Family history of sudden cardiac death
Differentials
Arrhythmias
AF
SVT
VT
PVCs / PACs
Sinus tachycardia
Systemic
Anaemia
Thyrotoxicosis
Fever
Hypoglycaemia
Psychological
Anxiety
Panic attacks
Other
Medication side effects
Dehydration
Electrolyte imbalance
Arrhythmia patterns
Regular tachycardia
SVT
Sinus tachycardia
Irregular tachycardia
AF
Frequent ectopics
Slow rhythm
Heart block
Sick sinus syndrome
Ectopic beats
PACs
PVCs
Clinical features
Symptom description
Fast
Slow
Irregular
Fluttering
Thumping
Associated symptoms
Chest pain
Dyspnoea
Dizziness
Syncope
Fatigue
Pattern
Sudden onset
Intermittent
Persistent
Triggered vs spontaneous
Complications
Cardiac
Syncope
Heart failure
Stroke (AF)
Systemic
Falls
Injury
Frailty
Delirium
Functional decline
Reduced mobility
Prognosis
Benign causes
Self‑limiting
Trigger‑related
Arrhythmias
Variable
Depends on underlying disease
Frailty
Higher risk of deterioration
Increased falls risk
Prevention
Lifestyle
Reduce stimulants
Alcohol moderation
Stress management
Medical
Optimise chronic disease
Medication review
Frailty
Hydration
Infection prevention
Avoid polypharmacy
Definition
Subjective sensation
Awareness of heartbeat
Fast / slow / irregular / pounding / fluttering
Physiological vs pathological
Benign causes
Arrhythmias
Systemic triggers