Does This Patient With Palpitations Have a Cardiac Arrhythmia?
This systematic review by the Rational Clinical Examination found that an arrhythmia was more likely (LR > 2) if that patient has:
- A history of cardiac disease (likelihood ratio [LR], 2.03; 95% CI, 1.33-3.11)
- Palpitations affected by sleeping (LR, 2.29; 95% CI, 1.33-3.94)
- Palpitations while at work (LR, 2.17; 95% CI, 1.19-3.96)
A arrhythmia was less likely (LR < 0.5) if that patient has:
- A known history of panic disorder (LR, 0.26; 95% CI, 0.07-1.01)
- Palpitations lasting less than 5 minutes (LR, 0.38; 95% CI, 0.22-0.63)
Additional findings that need further discussion are:
- Description by the patient of an irregular heart rate was an independent predictor of a cardiac arrhythmia(PMID: 8629647). The authors of the systematic review did not conclude this finding was helpful because the likelihood ratio, while significant, was within 0.5 to 2.0.
- An increased number of symptoms suggested psychiatric causes in the univarate, but not multivariate analysis of Weber (PMID: 8629647). This finding is part of a theme in general that the more symptoms are present the more likely there is an underlying psychiatric diagnosis in the evaluation of syncope (PMID: 17397948) and symptoms in general in primary care (PMID: 7987511).
This has been added to http://en.citizendium.org/wiki/Palpitation.
Citation:
Thavendiranathan, P., Bagai, A., Khoo, C., Dorian, P., & Choudhry, N. (2009). Does This Patient With Palpitations Have a Cardiac Arrhythmia? JAMA: The Journal of the American Medical Association, 302 (19), 2135-2143 DOI: 10.1001/jama.2009.1673 – PMID 19920238
