S2D: The Symptom to Diagnosis Podcast Palpitations
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Apr 15, 2022 This discussion dives into the case of a 70-year-old woman experiencing troubling palpitations. The hosts explore various potential causes, highlighting that most palpitations are actually non-cardiac. They provide insight into diagnostic strategies, emphasizing the importance of recognizing anxiety and substance use as factors. With a focus on key testing options and misinterpretations, the episode reveals how diagnosis can evolve through careful evaluation. The use of consumer health devices also sparks a debate about their role in monitoring heart rhythms.
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Widen Your Palpitations Differential
- Do use a broad differential for palpitations: cardiac, high-output, endocrine, catecholamines, substances, and psychiatric causes.
- Ask specifically about caffeine, alcohol, drugs, pregnancy, anemia, fever, and thyroid disease as triggers.
Holiday Heart: AFib After Drinking
- Adam recalled admitting a VA patient with AFib after drinking on July 4th and noted a prior AFib admission on Memorial Day.
- He used this to illustrate 'holiday heart' from alcohol bingeing.
Most Palpitations Aren't Cardiac
- Cardiac causes are only a minority of palpitations in some series; many are psychiatric or substance-related.
- A well-designed evaluation yields a specific diagnosis in most patients.
