Primary Care Setting: Analyzing Palpitations
In the primary care setting, palpitations are a frequent presenting symptom. Palpitations can be alarming to individuals and is often described as an uncomfortable awareness or an unusual feeling of one’s heart beating. Other common descriptive terms for palpitations include: feeling the heart beating faster, working harder, fluttering, skipping a beat, or the heart rate being abnormal. A practitioner working in the Primary Care Setting must be cognizant of causes of this symptom, pertinent questions to ask the patient in order to narrow down possible causes, current treatment methodology, all while being able to articulate and provide comfort and guidance to the patient throughout the continuum.
Definition and Prevalence
Palpitations are a sensation caused from the heart either beating irregularly, forcefully or rapidly. Although these sensations are caused by the heart, most are harmless and resolve without intervention, however, it can signify an underlying condition, or an arrhythmia. Palpitations do not necessarily signify an abnormal heart rhythm. Arrhythmias are caused by conduction/electrical abnormalities within the heart and can be benign or life threatening. Palpitations can be a result of a mild to life threatening condition, determining the root cause is vital.
Less than half of people who have arrhythmias experience palpitations. A general practitioner, with an average patient size of 2,000 clients, will average six patients or more per year with new-onset palpitation; 16 % of patients will present with this chief complaint. Patients experiencing new onset of palpitations or have a history of but symptoms are more frequent, bothersome or are accompanied by other symptoms, should obtain an evaluation from a practitioner.
It is paramount that the practitioner utilizes a systematic approach during the subjective portion of the health history interview. Obtaining the chief complaint, history of present illness, past medical history, social history, family health history, and a through review of systems is the fundamental methodology that all practitioners must employ. Utilizing this style will ensure a meticulous exploration the symptom, and will give key elements that will assist the practitioner in developing differential diagnoses. Employing the OLDCART acronym (onset, location, duration, characteristics, aggravating factors, relieving factors and treatment) will be the beginning of exploration of potential causes. The following set of questions should also be explored:
• When did the palpitations begin?
• How long do they last?
• How often do they occur?
• Do they start and stop suddenly?
• Does the heartbeat feel steady (regular) or irregular?
• Are there any other symptoms that accompany them?
• Is there a pattern?
• Is there an established history of palpitations?
• Have you ever been evaluated for palpitations by a specialist?
• Has any doctor or practitioner...