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Subha V. Raman - One of the best experts on this subject based on the ideXlab platform.
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Palpitations: Evaluation in the Primary Care Setting.
American family physician, 2017Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem in the ambulatory primary care setting, and cardiac causes are the most concerning etiology. Psychiatric illness, adverse effects of prescription and over-the-counter medications, and substance use should also be considered. Distinguishing cardiac from noncardiac causes is important because of the risk of sudden death in those with an underlying cardiac etiology. A thorough history and physical examination, followed by targeted diagnostic testing, can distinguish cardiac conditions from other causes of Palpitations. Persons with a history of cardiovascular disease, Palpitations at work, or Palpitations that affect sleep have an increased risk of a cardiac cause. A history of cardiac symptoms, a family history concerning for cardiac dysrhythmias, or abnormal physical examination or electrocardiography findings should prompt a more in-depth evaluation for heart disease. Ischemic symptoms may signal coronary heart disease and associated ventricular premature contractions that may warrant exercise stress testing. Exertional symptoms accompanied by elevated jugular venous pressure, rales, or lower extremity edema should raise concern for heart failure; imaging may be required to assess for functional and structural heart disease.
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Outpatient Approach to Palpitations
American family physician, 2011Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem seen in family medicine; most are of cardiac origin, although an underlying psychiatric disorder, such as anxiety, is also common. Even if a psychiatric comorbidity does exist, it should not be assumed that Palpitations are of a noncardiac etiology. Discerning cardiac from noncardiac causes is important given the potential risk of sudden death in those with an underlying cardiac etiology. History and physical examination followed by targeted diagnostic testing are necessary to distinguish a cardiac cause from other causes of Palpitations. Standard 12-lead electrocardiography is an essential initial diagnostic test. Cardiac imaging is recommended if history, physical examination, or electrocardiography suggests structural heart disease. An intermittent event (loop) monitor is preferred for documenting cardiac arrhythmias, particularly when they occur infrequently. Ventricular and atrial premature contractions are common cardiac causes of Palpitations; prognostic significance is dictated by the extent of underlying structural heart disease. Atrial fibrillation is the most common arrhythmia resulting in hospitalization; such patients are at increased risk of stroke. Patients with supraventricular tachycardia, long QT syndrome, ventricular tachycardia, or Palpitations associated with syncope should be referred to a cardiologist.
Randell K. Wexler - One of the best experts on this subject based on the ideXlab platform.
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Palpitations: Evaluation in the Primary Care Setting.
American family physician, 2017Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem in the ambulatory primary care setting, and cardiac causes are the most concerning etiology. Psychiatric illness, adverse effects of prescription and over-the-counter medications, and substance use should also be considered. Distinguishing cardiac from noncardiac causes is important because of the risk of sudden death in those with an underlying cardiac etiology. A thorough history and physical examination, followed by targeted diagnostic testing, can distinguish cardiac conditions from other causes of Palpitations. Persons with a history of cardiovascular disease, Palpitations at work, or Palpitations that affect sleep have an increased risk of a cardiac cause. A history of cardiac symptoms, a family history concerning for cardiac dysrhythmias, or abnormal physical examination or electrocardiography findings should prompt a more in-depth evaluation for heart disease. Ischemic symptoms may signal coronary heart disease and associated ventricular premature contractions that may warrant exercise stress testing. Exertional symptoms accompanied by elevated jugular venous pressure, rales, or lower extremity edema should raise concern for heart failure; imaging may be required to assess for functional and structural heart disease.
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Outpatient Approach to Palpitations
American family physician, 2011Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem seen in family medicine; most are of cardiac origin, although an underlying psychiatric disorder, such as anxiety, is also common. Even if a psychiatric comorbidity does exist, it should not be assumed that Palpitations are of a noncardiac etiology. Discerning cardiac from noncardiac causes is important given the potential risk of sudden death in those with an underlying cardiac etiology. History and physical examination followed by targeted diagnostic testing are necessary to distinguish a cardiac cause from other causes of Palpitations. Standard 12-lead electrocardiography is an essential initial diagnostic test. Cardiac imaging is recommended if history, physical examination, or electrocardiography suggests structural heart disease. An intermittent event (loop) monitor is preferred for documenting cardiac arrhythmias, particularly when they occur infrequently. Ventricular and atrial premature contractions are common cardiac causes of Palpitations; prognostic significance is dictated by the extent of underlying structural heart disease. Atrial fibrillation is the most common arrhythmia resulting in hospitalization; such patients are at increased risk of stroke. Patients with supraventricular tachycardia, long QT syndrome, ventricular tachycardia, or Palpitations associated with syncope should be referred to a cardiologist.
Eric N Prystowsky - One of the best experts on this subject based on the ideXlab platform.
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utility of mobile cardiac outpatient telemetry for the diagnosis of Palpitations presyncope syncope and the assessment of therapy efficacy
Journal of Cardiovascular Electrophysiology, 2007Co-Authors: Jeff A Olson, Andrew M Fouts, Benzy J Padanilam, Eric N PrystowskyAbstract:INTRODUCTION: Continuous mobile cardiac outpatient telemetry (MCOT) may have several advantages over traditional ambulatory monitoring systems in the diagnostic evaluation of symptoms such as Palpitations, dizziness, and syncope. However, only limited published data are available showing its advantages. METHODS AND RESULTS: We reviewed the records of 122 consecutive patients evaluated using MCOT for Palpitations, presyncope/syncope, or to monitor the efficacy of a specific antiarrhythmic therapy. Ten of 17 patients (59%) studied for presyncope/syncope had a diagnosis made with MCOT. Eight of these 17 patients had a previous negative evaluation for presyncope/syncope and five had an event correlated with the heart rhythm during the monitoring period. Nineteen patients monitored for Palpitations or presyncope/syncope were asymptomatic during monitoring but had a prespecified arrhythmia detected. When MCOT was used as the first ambulatory monitoring system to evaluate Palpitations (n = 18), 73% of patients correlated their symptoms with the underlying cardiac rhythm. Seven of 21 patients monitored for medication titration had dosage adjustments during outpatient monitoring. CONCLUSIONS: MCOT can detect asymptomatic clinically significant arrhythmias, and was especially useful to identify the cause of presyncope/syncope, even in patients with a previous negative workup. This outpatient monitoring system allows patients to undergo daily medication dose titration in the outpatient setting, thus avoiding hospitalization.
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utility and cost of event recorders in the diagnosis of Palpitations presyncope and syncope
American Journal of Cardiology, 1997Co-Authors: Richard I Fogel, Joseph J Evans, Eric N PrystowskyAbstract:: In 184 patients given an event recorder for the evaluation of Palpitations, syncope or presyncope, we found that event recorders are useful and relatively inexpensive in the initial evaluation of patients with Palpitations regardless of the presence of heart disease, and of syncopal or presyncopal patients without heart disease. In patients with presyncope or syncope who have heart disease and a negative electrophysiology evaluation, event recorders have less utility and are more costly.
Adam Pleister - One of the best experts on this subject based on the ideXlab platform.
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Palpitations: Evaluation in the Primary Care Setting.
American family physician, 2017Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem in the ambulatory primary care setting, and cardiac causes are the most concerning etiology. Psychiatric illness, adverse effects of prescription and over-the-counter medications, and substance use should also be considered. Distinguishing cardiac from noncardiac causes is important because of the risk of sudden death in those with an underlying cardiac etiology. A thorough history and physical examination, followed by targeted diagnostic testing, can distinguish cardiac conditions from other causes of Palpitations. Persons with a history of cardiovascular disease, Palpitations at work, or Palpitations that affect sleep have an increased risk of a cardiac cause. A history of cardiac symptoms, a family history concerning for cardiac dysrhythmias, or abnormal physical examination or electrocardiography findings should prompt a more in-depth evaluation for heart disease. Ischemic symptoms may signal coronary heart disease and associated ventricular premature contractions that may warrant exercise stress testing. Exertional symptoms accompanied by elevated jugular venous pressure, rales, or lower extremity edema should raise concern for heart failure; imaging may be required to assess for functional and structural heart disease.
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Outpatient Approach to Palpitations
American family physician, 2011Co-Authors: Randell K. Wexler, Adam Pleister, Subha V. RamanAbstract:Palpitations are a common problem seen in family medicine; most are of cardiac origin, although an underlying psychiatric disorder, such as anxiety, is also common. Even if a psychiatric comorbidity does exist, it should not be assumed that Palpitations are of a noncardiac etiology. Discerning cardiac from noncardiac causes is important given the potential risk of sudden death in those with an underlying cardiac etiology. History and physical examination followed by targeted diagnostic testing are necessary to distinguish a cardiac cause from other causes of Palpitations. Standard 12-lead electrocardiography is an essential initial diagnostic test. Cardiac imaging is recommended if history, physical examination, or electrocardiography suggests structural heart disease. An intermittent event (loop) monitor is preferred for documenting cardiac arrhythmias, particularly when they occur infrequently. Ventricular and atrial premature contractions are common cardiac causes of Palpitations; prognostic significance is dictated by the extent of underlying structural heart disease. Atrial fibrillation is the most common arrhythmia resulting in hospitalization; such patients are at increased risk of stroke. Patients with supraventricular tachycardia, long QT syndrome, ventricular tachycardia, or Palpitations associated with syncope should be referred to a cardiologist.
Maurizio Lunati - One of the best experts on this subject based on the ideXlab platform.
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external prolonged electrocardiogram monitoring in unexplained syncope and Palpitations results of the synarr flash study
Europace, 2016Co-Authors: E T Locati, Angel Moya, Mario Oliveira, Hildegard Tanner, Rik Willems, Maurizio Lunati, Michele BrignoleAbstract:Aims SYNARR-Flash study (Monitoring of SYNcopes and/or sustained Palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained Palpitations of suspected arrhythmic origin. Methods and results Consecutive patients were enrolled within 1 month after unexplained syncope or Palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T®, Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia 6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with Palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0–15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3–29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4–9.7, P = 0.018). For Palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent Palpitations ( P < 0.001) and early start of recording ( P = 0.001). Conclusion The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.
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role of extended external loop recorders for the diagnosis of unexplained syncope pre syncope and sustained Palpitations
Europace, 2014Co-Authors: Emanuela T Locati, Anna Maria Vecchi, Sara Vargiu, Giuseppe Cattafi, Maurizio LunatiAbstract:Aims To assess the diagnostic yield of new external loop recorders (ELRs) in patients with history of syncope, pre-syncope, and sustained Palpitations. Methods and results Since 2005, we have established a registry including patients who consecutively received ELR monitoring for unexplained syncope or pre-syncope/Palpitations. The registry included 307 patients (61% females, age 58 ± 19 years, range 8–94 years) monitored by high-capacity memory ELR of two subsequent generations: SpiderFlash-A® (SFA®, Sorin CRM), storing two-lead electrocardiogram (ECG) patient-activated recordings by loop-recording technique (191 patients, 54 patients with syncope, years 2005–09), and SpiderFlash-T® (SFT®), adding auto-trigger detection for pauses, bradycardia, and supraventricular/ventricular arrhythmias (116 patients, 38 patients with syncope, years 2009–12). All the patients previously underwent routine workup for syncope or palpitation, including one or more 24 h Holter, not conclusive for diagnosis. Mean monitoring duration was 24.1 ± 8.9 days. Among 215 patients with Palpitations, a conclusive diagnosis was obtained in 184 patients (86% diagnostic yield for palpitation). Among 92 patients with syncope, a conclusive diagnosis was obtained in 16 patients (17% clinical diagnostic yield for syncope), with recording during syncope of significant arrhythmias in 9 patients, and sinus rhythm in 7 patients. Furthermore, asymptomatic arrhythmias were de novo detected in 12 patients (13%), mainly by auto-trigger detection, suggesting an arrhythmic origin of the syncope. Conclusions The diagnostic yield of ELR in patients with syncope, pre-syncope, or palpitation of unknown origin after routine workup was similar to implantable loop recorder (ILR) within the same timeframe, therefore, ELR could be considered for patients candidate for long-term ECG monitoring, stepwise before ILR.
