Sign in
Medicine

Palpitation

Tammy Robbins, a 48-year-old woman, has been experiencing heart racing and chest discomfort for the past three days. Conduct a focused history and physical examination. Vitals: BP 90/70 mm Hg, HR 146/min (irregular), RR 16/min, and temperature 37.5°C.

Canadaprep

• 6 min read
Tammy Robbins, a 48-year-old woman, has been experiencing heart racing and chest discomfort for the past three days. Conduct a focused history and physical examination. Her vital signs are as follows: blood pressure 90/70 mm Hg, heart rate 146/min (irregular), respiratory rate 16/min, and temperature 37.5°C.

History of present illness

  • Onset: gradual onset? (more common), sudden? (tachycardia due to reentry)
  • Course: Is it continuous or intermittent?
  • Duration: Is it the first time or have you had it before? If prior episodes - When and how were you diagnosed? What treatment were you given at that time? When was the last episode? How long did it last?
  • Quality: Do you feel that your heart is going fast or is it skipping beats?
  • Associations: Are the symptoms precipitated by caffeine, chocolate, or food/coke? Is it related to activity? How many blocks are you able to walk?

Review of symptoms

  • CVA: Any weakness, numbness, difficulty finding words, or visual problems?
  • Cardiac: Shortness of breath? swelling of legs? How many pillows do you use? Chest pain? Dizziness or loss of consciousness?
  • GI: Severe vomiting or diarrhea (electrolytes disturbances)
  • Endocrine: Weight loss? (hyperthyroidism), Episodic pallor, tremor, headache, diaphoresis? (pheochromocytoma)
  • Pulmonary: Wheezes/cough/chest tightness? (Asthma/lung disease)
🔺 RED FLAGS: Associated chest pain, syncope, dyspnea. History of cardiac disease. Duration of episode > 5 mins. Significant family history.

Past medical/surgical history

  • Do you take medications on regular basis? Any new medication? (beta-agonists, antiarrhythmics, pseudoephedrine, tricyclics, herbal medication)
  • Cardiac risk factors (smoking, DM, HTN, dyslipidemia, family history).
  • Past history of Atrial Fibrillation, Wolff-Parkinson-White (WPW) syndrome, arrhythmias, CAD, Congestive heart failure, DM, stroke, TIA, syncope.
  • History of thyroid disease, any sweating/diarrhea?
  • Recent surgery or immobilization? (Pulmonary embolism)

Social/Family history

  • Family history of sudden death at a young age? (cardiomyopathy)
  • Caffeine, smoking, alcohol?
  • Recreational drugs: cocaine, amphetamines, opiates?

Patient Encounter Probe

Palpitations involve the sensation of a rapid or irregular heartbeat and are a common symptom. While they are often benign, they can also be a sign of a more serious underlying issue.