Palpitations

Question 1

What key history would you obtain from a patient that complains of palpitations?

Answer 1

Gradual vs. acute onset/offset
Context (exertion, caffeine, anxiety)
Associated symptoms (lightheadedness, chest pain, dyspnea)
Hyperthyroid symptoms
History of bleeding or anemia
History of heart disease

Question 2

What key physical exams would you obtain on a patient that complains of palpitations?

Answer 2

Vital Signs
Endocrine/thyroid exam (exophthalmos, lid retraction, lid lag, gland size, bruit and tremor)
Complete cardiovascular exam

Question 3

70 yo diabetic M presents with episodes of palpitations and diaphoresis. He is on insulin. Differentials?

Answer 3

Hypoglycemia
Cardiac arrhythmia
Angina
Hyperthyroidism
Hyperventilation episodes
Panic attacks
Pheochromocytoma

Question 4

70 yo diabetic M presents with episodes of palpitations and diaphoresis. He is on insulin. Differentials: hypoglycemia, cardiac arrhythmia, angina, hyperthyroidism, hyperventilation episodes, panic attacks, pheochromocytoma. Workup?

Answer 4

Glucose
Carcinoid
CBC, electrolytes
TSH
BUN/Cr
ECG
Holter monitor