New-onset palpitations in general practice: assessing the discriminant value of items within the clinical history

Summerton, Nick; Mann, Steven; Rigby, Alan S.; Petkar, Sanjiv; Dhawan, Jeevanshu

doi:10.1093/fampra/18.4.383

Cited by 42 publications

(38 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar observations were found in a study by Summerton et al which showed palpitations during exertion had cardiac aetiology. 5 Associated symptoms of palpitation were chest pain, shortness of breath and syncope. Chest pain was encountered in 9 % and shortness of breath was present in 17 % of patients.…”

Section: Discussionmentioning

confidence: 99%

The aetiological profile of new onset palpitations in natives of Western Himalayas: a cross sectional observational study

et al. 2017

View full text Add to dashboard Cite

Background: Palpitation is a common presenting complaint in out patient department. Etiological profile of such patients has not been studied in the recent past. The aim of the study was to study the aetiological profile of patients with new onset palpitations in North Indian tertiary health care centre.Methods: 130 consecutive patients of new onset palpitations were enrolled in the study and the aetiological profile of palpitation was evaluated using detailed history, examination and investigations.Results: The study group had 53% female and 47% male with a ratio of 1.13:1. Majority of the patients in the age group of 18-29 years. The mean age was 32.04+15.14 years. Most common symptom associated was shortness of breath seen in 17% patients. Of the 130 patients 43.8% of patients had cardiac aetiology, 35.38% psychiatric and 20% had miscellaneous aetiology. Among cardiac aetiology, arrhythmias were most common. PSVT was encountered in 15.4% and AF in 13.1%of the total patients. Psychiatry causes were observed in 35% of patients. In psychiatric causes 71.7% patients had panic attack whereas 28.2% patients had generalised anxiety disorder (GAD). In third group of miscellaneous causes which was 20% of total 6.9% had anaemia, 10% hyperthyroidism and 3.8% were on beta agonists.Conclusions: Palpitation is a presenting symptom of various diseases. The cause can be easily ascertained in most of the patients by a good history and examination; serious cardiac diseases require special investigation. Palpitation as a symptom should not be overlooked the underlying cause must be identified; this can be a helpful clue to improve patient outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

The aetiological profile of new onset palpitations in natives of Western Himalayas: a cross sectional observational study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…[7] In Summerton study, involving patients with new onset palpitations in general practice, 19% of patients had significant cardiac arrhythmia. [6] In Chu study, involving patients in a regional Accident and Emergency Department of Hong Kong arranged for Holter monitoring, 16.7% of patients presented with palpitation were found to have significant cardiac arrhythmia. [11] Around 2,688 patients underwent Holter monitoring for investigation of palpitation in Sreenkumar study, the commonest two findings were 6.6% paroxysmal atrial fribrillation (PAF) and 4.4% frequent ectopics.…”

Section: Discussionmentioning

confidence: 99%

“…[6] " New onset" palpitation referred to patient's symptom(s) had occurred within 3 months preceding the first visit to the clinic. Patient who had a history of previous episodes of palpitation or palpitation had occurred more than 3 months was defined as "old" symptom.…”

Section: Definition and Holter Monitoringmentioning

confidence: 99%

“…[6] All diagnosis of significant cardiac arrhythmia will be referred to medical specialist for further evaluation and management.…”

Section: Definition and Holter Monitoringmentioning

confidence: 99%

“…second degree or third degree, sick sinus syndrome (SSS), prolong QT interval, or significant change in ST segment. [6,11] Insignificant cardiac arrhythmia encompassed patients with non-pathological atrial or ventricular ectopy, e.g. sporadic, occasional unifocal ectopy.…”

Section: Definition and Holter Monitoringmentioning

confidence: 99%

See 2 more Smart Citations

Holter Monitoring (Ambulatory Electrocardiography) Defined Cardiac Arrhythmia Among Patients Presented with Palpitation in the Primary Care Setting

Chiang

2017

JFMHC

View full text Add to dashboard Cite

Palpitation is non-specific and represents one of the most common symptoms in general medical settings.Discerning cardiac from noncardiac causes is important. A 24-hour ambulatory electrocardiography (Holter) monitor is usually used. This is a retrospective cross-sectional review including all patients presented with palpitation and had Holter monitoring performed in a regional primary care clinic of Hong Kong during the year 2010 to 2014. Clinical information and Holter outcomes were retrieved and analyzed to examine Holter monitoring defined significant cardiac arrhythmia and assess the predictive patient characteristics associated with significant cardiac arrhythmia. Holter monitoring were arranged for 89 (31.9%) male and 190 (68.1%) female patients. 163 (58.4%) patients had associated chronic comorbidity, including 38.0% had hypertension. 109 (39.1%) Holter monitoring showed significant cardiac arrhythmia, including prolong QT interval (11.1%), frequent supraventricular/ventricular ectopics (9.0%) and supraventricular/ventricular ectopics in bigeminy or trigeminy (5.0%). Patients who were smokers, or with concomitant ischaemic heart disease were more likely to have significant cardiac arrhythmia (P < 0.05). 39.1% of Holter monitoring for patients presented with palpitation in the primary care setting have significant cardiac arrhythmia, which need referral to medical specialist for further management.

show abstract

Does This Patient With Palpitations Have a Cardiac Arrhythmia?

Thavendiranathan

Bagai

Khoo³

et al. 2009

JAMA

View full text Add to dashboard Cite

Context Many patients have palpitations and seek advice from general practitioners. Differentiating benign causes from those resulting from clinically significant cardiac arrhythmia can be challenging and the clinical examination may aid in this process.Objective To systematically review the accuracy of historical features, physical examination, and cardiac testing for the diagnosis of cardiac arrhythmia in patients with palpitations. MEDLINE (1950 to August 25, 2009 and EMBASE (1947 to August 2009) searches of English-language articles that compared clinical features and diagnostic tests in patients with palpitations with a reference standard for cardiac arrhythmia. Of the 277 studies identified by the search strategy, 7 studies were used for accuracy analysis and 16 studies for diagnostic yield analysis. Two authors independently reviewed articles for study data and quality and a third author resolved disagreements. Data Source, Study Selection, and Data ExtractionData Synthesis Most data were obtained from single studies with small sample sizes. A known history of cardiac disease (likelihood ratio [LR], 2.03; 95% confidence interval [CI], 1.33-3.11), having palpitations affected by sleeping (LR, 2.29; 95% CI, 1.33-3.94), or while the patient is at work (LR, 2.17; 95% CI, 1.19-3.96) slightly increase the likelihood of a cardiac arrhythmia. A known history of panic disorder (LR, 0.26; 95% CI, 0.07-1.01) or having palpitations lasting less than 5 minutes (LR, 0.38; 95% CI, 0.22-0.63) makes the diagnosis of cardiac arrhythmia slightly less likely. The presence of a regular rapid-pounding sensation in the neck (LR, 177; 95% CI, 25-1251) or visible neck pulsations (LR, 2.68; 95% CI, 1.25-5.78) in association with palpitations increases the likelihood of a specific type of arrhythmia (atrioventricular nodal reentry tachycardia). The absence of a regular rapid-pounding sensation in the neck makes detecting the same arrhythmia less likely (LR, 0.07; 95% CI, 0.03-0.19). No other features significantly alter the probability of clinically significant arrhythmia. Diagnostic tests for prolonged periods of electrocardiographic monitoring vary in their yield depending on the modality used, duration of monitoring, and occurrence of typical symptoms during monitoring. Loop monitors have the highest diagnostic yield (34%-84%) for identifying an arrhythmia.Conclusions While the presence of a regular rapid-pounding sensation in the neck or visible neck pulsations associated with palpitations makes the diagnosis of atrioventricular nodal reentry tachycardia likely, the reviewed studies suggest that the clinical examination is not sufficiently accurate to exclude clinically significant arrhythmias in most patients. Thus, prolonged electrocardiographic monitoring with demonstration of symptom-rhythm correlation is required to make the diagnosis of a cardiac arrhythmia for most patients with recurrent palpitations.

show abstract

New-onset palpitations in general practice: assessing the discriminant value of items within the clinical history

Cited by 42 publications

References 10 publications

The aetiological profile of new onset palpitations in natives of Western Himalayas: a cross sectional observational study

The aetiological profile of new onset palpitations in natives of Western Himalayas: a cross sectional observational study

Holter Monitoring (Ambulatory Electrocardiography) Defined Cardiac Arrhythmia Among Patients Presented with Palpitation in the Primary Care Setting

Does This Patient With Palpitations Have a Cardiac Arrhythmia?

Contact Info

Product

Resources

About