Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
GENERAL EXAMINATION ANDSYSTEMIC EXAMINATION IN ACASE OF PALPITATION
PALPITATION   Definition:    „an awareness of ones heartbeat that is thought    inappropriate to the circumstances
GENERAL EXAMINATION PATIENT PANIC / NOT PANIC BUILT AND NOURISHMENT PALLOR ICTERUS CYANOSIS CLUBBING LYMPHADENOPATH...
GENERAL EXAMINATION   VITALS    PULSE-         RATE- tachycardia/bradycardia               Heart rate >120 beats/min or <...
GENERAL EXAMINATION          Intermittent and irregular/ felt as   missed beats- Ectopics   Volume-high/low   character-no...
GENERAL EXAMINATION   BP    Hypotension / Hypertension
SYSTEMIC EXAMINATION INSPECTION shape of precodium Position of apex beat Visible pulsations-jvp elevated/not Visible ...
SYSTEMIC EXAMINATION Palpation Palpation of the apcal impulse Left parasternal heave Sub xiphoid pulsations Palpation...
SYSTEMIC EXAMINATION Percussion Identfy whether heart is enlarged or not
SYSTEMIC EXAMINATION Auscultation S1 S2 Ejection sounds murmurs
Resting ECG• Features to check    Sinus rhythm / arrhythmia    PR interval    QRS duration    QT Intervals    ST segment s...
KEY CLINICAL FINDINGS WITH PALPITATIONS ANDSUGGESTED DIAGNOSES   Finding                           Suggested diagnosis ...
KEY CLINICAL FINDINGS WITH PALPITATIONS ANDSUGGESTED DIAGNOSES   Finding                                    Suggested di...
EVALUATING A PATIENT WITH PALPITATIONS
DIFFERENTIAL DIAGNOSIS OFPALPITATIONS   ARRHYTHMIAS   Atrial fibrillation/flutter   Bradycardia caused by advanced arte...
DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Psychiatric causes Anxiety disorder Panic attacks Drugs and medications Alcohol...
DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Nonarrhythmic cardiac causes Atrial or ventricular septal defect Cardiomyopathy ...
DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Extracardiac causes Anemia Electrolyte imbalance Fever Hyperthyroidism Hypogly...
Upcoming SlideShare
Loading in …5
×

Examination in palpitation

2,900 views

Published on

for download go to
http://medicalpresentation.blogspot.in/2012/09/palpitation.html

Published in: Health & Medicine
  • Be the first to comment

Examination in palpitation

  1. 1. GENERAL EXAMINATION ANDSYSTEMIC EXAMINATION IN ACASE OF PALPITATION
  2. 2. PALPITATION Definition: „an awareness of ones heartbeat that is thought inappropriate to the circumstances
  3. 3. GENERAL EXAMINATION PATIENT PANIC / NOT PANIC BUILT AND NOURISHMENT PALLOR ICTERUS CYANOSIS CLUBBING LYMPHADENOPATHY EDEMA
  4. 4. GENERAL EXAMINATION VITALS PULSE- RATE- tachycardia/bradycardia Heart rate >120 beats/min or < 45 beats/min while at rest RHYTHM- Regular- occasional-SVT/VT continuous-sinus tachycardia high output states Irregular- Atrial Fibrillation / Ectopics sustained and irregularly irregular /chaotic -AF
  5. 5. GENERAL EXAMINATION Intermittent and irregular/ felt as missed beats- Ectopics Volume-high/low character-normal/abnormal Condition of vessel wall-thickened/not thickend Radiofemoral delay-present/absent peripheral pulsations-felt normal/not
  6. 6. GENERAL EXAMINATION BP Hypotension / Hypertension
  7. 7. SYSTEMIC EXAMINATION INSPECTION shape of precodium Position of apex beat Visible pulsations-jvp elevated/not Visible scars
  8. 8. SYSTEMIC EXAMINATION Palpation Palpation of the apcal impulse Left parasternal heave Sub xiphoid pulsations Palpation of the pulmonary arterial pulsation Thrills – palpable murmurs
  9. 9. SYSTEMIC EXAMINATION Percussion Identfy whether heart is enlarged or not
  10. 10. SYSTEMIC EXAMINATION Auscultation S1 S2 Ejection sounds murmurs
  11. 11. Resting ECG• Features to check Sinus rhythm / arrhythmia PR interval QRS duration QT Intervals ST segment shape (LVH/Brugada) T waves (? Cardiomyopathy)
  12. 12. KEY CLINICAL FINDINGS WITH PALPITATIONS ANDSUGGESTED DIAGNOSES Finding  Suggested diagnosis Single “skipped” beats  Benign ectopy Feeling of being unable to  Ventricular premature catch one‟s breath contractions Single pounding sensations  Ventricular premature Rapid, regular pounding in contractions neck  Supraventricular Palpitations that are worse arrhythmias at night  Benign ectopy or atrial Palpitations associated with fibrillation emotional distress  Psychiatric etiology or Palpitations associated with catecholamine-sensitive activity arrhythmia General anxiety  Coronary heart disease  Panic attacks
  13. 13. KEY CLINICAL FINDINGS WITH PALPITATIONS ANDSUGGESTED DIAGNOSES Finding  Suggested diagnosis Medication or recreational drug use  Drug-induced palpitations Rapid palpitations with exercise  Supraventricular arrhythmia, atrial fibrillation Positional palpitations  Atrioventricular nodal tachycardia, pericarditis Heat intolerance, tremor, thyromegaly  Hyperthyroidism Palpitations since childhood Rapid, irregular rhythm  Supraventricular tachycardia  Atrial fibrillation, tachycardia with Palpitations terminated by vagal variable block maneuvers  Supraventricular tachycardia Heart murmur Midsystolic click  Heart valve disease Friction rub  Mitral valve prolapse  Pericarditis
  14. 14. EVALUATING A PATIENT WITH PALPITATIONS
  15. 15. DIFFERENTIAL DIAGNOSIS OFPALPITATIONS ARRHYTHMIAS Atrial fibrillation/flutter Bradycardia caused by advanced arteriovenous block or sinus node dysfunction Bradycardia-tachycardia syndrome(sick sinus syndrome) Multifocal atrial tachycardia Premature supraventricular or ventricular contractions Sinus tachycardia or arrhythmia Supraventricular tachycardia Ventricular tachycardia Wolff-Parkinson-White syndrome
  16. 16. DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Psychiatric causes Anxiety disorder Panic attacks Drugs and medications Alcohol Caffeine Certain prescription and over-the-counter agents (e.g., digitalis, phenothiazine, theophylline, beta agonists) Street drugs (e.g., cocaine) Tobacco
  17. 17. DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Nonarrhythmic cardiac causes Atrial or ventricular septal defect Cardiomyopathy Congenital heart disease Congestive heart failure Mitral valve prolapsed Pacemaker-mediated tachycardia Pericarditis Valvular disease (e.g., aortic insufficiency, stenosis)
  18. 18. DIFFERENTIAL DIAGNOSIS OFPALPITATIONS Extracardiac causes Anemia Electrolyte imbalance Fever Hyperthyroidism Hypoglycemia Hypovolemia Pheochromocytoma Pulmonary disease Vasovagal syndrome

×