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Is there fever? If there is fever, one should look for yellow fever, diphtheria, cerebral abscess, or meningitis. Perhaps the fever is related to increased intracranial pressure from apoplexy.
Are there ... DIAGNOSTIC WORKUP
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Are the palpitations constant or intermittent? Constant palpitations may signify tachycardia, and that would suggest hyperthyroidism or overuse of caffeine and other drugs. Intermittent palpitations are more likely related to a ... DIAGNOSTIC WORKUP
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Is there a positive alcohol or drug history? It is well known that alcohol can cause a myocardiopathy. Atropine, caffeine, and many other substances can cause a tachycardia.
Is the heart rate below 160 and/or reduced by ... DIAGNOSTIC WORKUP
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Is it acute or chronic? An acute cardiac arrhythmia should make one consider a myocardial infarction first.
Is the heart rate slow, normal, or fast? A rapid cardiac arrhythmia may be associated with hyperthyroidism, ... DIAGNOSTIC WORKUP
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Could the murmur be extracardiac in origin? Extracardiac murmurs include the pericardial friction rub and cardiorespiratory murmurs.
Is the murmur continuous? A continuous murmur is most often due to a patent ductus ... DIAGNOSTIC WORKUP
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Bradycardia is defined as heart rate of less than 60 beats per minute. It is a common finding that often does not require treatment in the absence of symptoms.
Differential Diagnosis
Sinus bradycardia
... Workup and Diagnosis ... Treatment
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...
Palpitations are the subjective sensation of the heart beating rapidly, strongly, or irregularly. It often means that a rapid heart rate is occurring, but it can also be seen even when the heart rate is normal, such as in anxious patients. The patient should be asked to describe the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Tachycardia is defined by a heart rate ≥100 beats per minute. Most tachyarrhythmias occur as a result of triggered activity, increased automaticity, or re-entry circuits. A 12-lead ECG is essential to determining the type of tachyarrhythmia present. Wide complex tachycardia must... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The patient should be asked to describe the heart rhythm and to demonstrate it by either saying or tapping the speed and rhythm of the sensation. Additionally, teaching the patient to measure his or her pulse during the episode may give more... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Diastolic heart murmurs are never normal and should always be further evaluated, in contrast to systolic murmurs, which are commonly benign or due to rapid flow rates. The part of the cardiac cycle that the murmur falls into (e.g. early, middle, or late) will help determine the etiology, as... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Systolic heart murmurs, in contrast to diastolic murmurs, may be normal or abnormal, although when coupled with a heave they are always abnormal. The part of the cardiac cycle that the murmur falls into (e.g., early, middle, or late) will help determine the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Bradycardia is a slow pulse (<90 in infants and <60 in children and adolescents). Causes range from the benign (athletic heart) to the life threatening (sepsis, severe heart block). Assessing the child's ABCs is the first priority.
Differential Diagnosis '>>... Workup and Diagnosis ... Treatment
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Most tachycardias in children are supraventricular and well tolerated, allowing time for proper evaluation and diagnosis. Cardiovascular collapse is rare but more common in those with a history of congenital heart disease and/or cardiac surgery.
... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Bradycardia (a heart rate below 60 beats/min) is not infrequently found during a routine physical examination. Visualizing the conduction system of the heart recalls the sick sinus syndrome, atrioventricular (A-V) nodal rhythm, or A-V block, but,
... READ EXCERPTS »
... The first consideration on hearing a heart murmur is to determine whether the murmur is functional or organic. Certainly, the low-grade systolic murmurs tend to be functional; if the murmur changes or disappears on position, inspiration, or exercise it is likely to be functional. A
... READ EXCERPTS »
... Tachycardia, like dyspnea, is usually a sign that the tissues are not getting enough oxygen to meet their demands. To recall a list of causes pathophysiology is applied. If tachycardia results from anoxia then the causes can be developed on the basis of the causes for
... READ EXCERPTS »
... With few exceptions, the etiologies of cardiac arrhythmias like those of bradycardia can best be recalled using the mnemonic VINDICATE. The exceptions are from one pathophysiologic cause: obstruction and consequent dilatation of one or more of the chambers of the heart. Thus,
... READ EXCERPTS »
... Because anxiety is the common cause of palpitations, there is a tremendous temptation to jump to this conclusion as the cause in an otherwise healthy looking individual. If we use the mnemonic VINDICATE, we may avoid a misdiagnosis in many cases.
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It's also a normal response to vagal stimulation caused by coughing, vomiting, or... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Defined as a conscious awareness of one’s heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping or as missing or skipping beats.... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... An absent or a weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized loss or weakness of a pulse that’s normally present and strong may... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A biferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more forceful than the second.... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Easily detected by counting the apical, carotid, or radial pulse, tachycardia is a heart rate greater than 100 beats/minute. The patient with tachycardia usually complains of palpitations or of a “racing” heart. This common sign... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Premature Beats
Extrasystole
Sinus (rare)
Atrial
Atrioventricular junctional
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... Regular rhythm at normal rates
Normal sinus rhythm
Accelerated junctional rhythm
Accelerated idioventricular rhythm
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... Systolic
Early systolic
Physiologic (innocent)
Small ventricular septal defect
Large ventricular
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... Palpitation without Arrhythmia
Noncardiac disorders
Anxiety
Exercise
Anemia
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... In cardiac arrhythmias (sometimes called cardiac dysrhythmias), abnormal electrical conduction or automaticity changes heart rate and rhythm. (See Normal cardiac conduction, page 1126.) Arrhythmias vary in severity, from those that are mild,... Causes ... Signs and symptoms ... Diagnosis ... Special considerations ... Pictures
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal stimulation caused by coughing, vomiting, or... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing can be... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Defined as a conscious awareness of one’s heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping, or as missing or... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... An absent or weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized loss or weakness of a pulse that’s normally present and strong... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A bisferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more forceful than the second. The first peak ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Easily detected by counting the apical, carotid, or radial pulse rate, tachycardia is a heart rate greater than 100 beats/ minute. The patient with tachycardia usually complains of palpitations or a “racing” heart. This common sign normally occurs in response to... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Paul C. Riggle and Richard W. Harper
Bradycardia, which is defined as a heart rate below 60 beats/minute, results from abnormalities in impulse formation or failure of atrioventricular (AV) conduction. As with all arrhythmias, the physician managing... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... David M. Schneider
Palpitations (PPTs), defined as an uncomfortable or abnormal awareness of the heart beat, are common in primary care patients. In one study, recurrent symptoms occurred in 75% of patients and 33% reported lower quality of life, but the 1... Approach ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment
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... Gehan Devendra
Tachycardia is commonly found in both hospitalized and ambulatory patients. It can be either physiologic or pathologic and is defined as a heart rate greater than 100 beats/ minute. Tachycardia can initiate in two main... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... David E. Anisman and Gerald F. Farnell
A diastolic murmur is a finding that provides a clue to an underlying disease process. Unlike their systolic counterparts (Chapter 7.7), diastolic murmurs almost always indicate underlying heart disease.
... History ... Physical examination (PE) ... Testing ... Diagnostic assessment ... Pictures
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... Dale Bishop
Systolic murmurs can herald significant clinical deterioration and sudden death, or they can represent stable or clinically insignificant conditions. Although technologic advances in cardiac diagnostic testing continue,... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
Sinus Bradycardia
❑ Hypothyroidism
❑ Hypervagotonia
❑ Hypersensitive carotid sinus
❑ Hypothermia ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Sinus tachycardia
❑ Paroxysmal supraventricular tachycardia
❑ Atrial fibrillation
❑ Atrial flutter ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Aortic regurgitation
❑ Pulmonic regurgitation
❑ Mitral stenosis
❑ Tricuspid stenosis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Systolic ejection murmur
❑ Mitral regurgitation
❑ Mitral valve prolapse
❑ Aortic stenosis ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Aortic stenosis/aortic insufficiency
❑ Pericardial friction rub
❑ Pulmonary arteriovenous fistula
❑... Diagnostic Approach ... Clinical Findings
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... Abnormal electrical conduction or automaticity changes heart rate and rhythm in cardiac arrhythmias, also called cardiac dysrhythmias. (See Types of cardiac arrhythmias.)
Arrhythmias vary in severity, from those that are mild, asymptomatic, and... Causes ... Special considerations ... Pictures
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal stimulation caused by coughing, vomiting, or straining during defecation.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing can be... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Defined as a conscious awareness of one’s heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping or as missing or skipping beats. Palpitations may... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Easily detected by counting the apical, carotid, or radial pulse, tachycardia is a heart rate greater than 100 beats/minute. The patient with tachycardia usually complains of palpitations or of a “racing” heart. This common sign normally occurs in... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal stimulation caused by coughing, vomiting, or... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality. (See Classifying murmurs.... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Defined as a conscious awareness of one’s own heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping, or as missing or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... An absent or weak pulse may be generalized or may affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized loss or weakness of a pulse that’s normally present... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A bisferiens pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more forceful than the second.... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Easily detected by counting the apical, carotid, or radial pulse, tachycardia is a heart rate greater than 100 beats/minute. The patient with tachycardia usually complains of palpitations or of a “racing” heart. This common sign... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Normal murmursare due to turbulence of normal blood flow. A normal murmur does not result insymptoms. Cardiovascular exam, chest radiograph, and ECG are normal.Other terms used to signify a normal murmur are benign, insignificant,or innocent. Pathologic... Principal Causes of Heart Murmurs (Asymptomatic) ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It's a normal response to vagal stimulation caused by coughing, vomiting, or... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They're classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing can... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Defined as a conscious awareness of one's heartbeat, palpitations are usually felt over the precordium or in the throat or neck. The patient may describe them as pounding, jumping, turning, fluttering, or flopping or as missing or skipping beats. Palpitations... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... An absent or a weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized loss or weakness of a pulse that's normally present and strong may... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A biferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more forceful than the second. The first peak (percussion wave)... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Easily detected by counting the apical, carotid, or radial pulse, tachycardia is a heart rate greater than 100 beats/minute. The patient with tachycardia usually complains of palpitations or of a “racing” heart. This common sign normally... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
Bradycardia (a heart rate below 60 beats per minute) is not
infrequently found during a routine physical examination. Visualizing the
conduction system of the heart recalls the sick sinus syndrome,
atrioventricular (A-V) nodal rhythm, or A-V block but,... Pictures
... READ EXCERPTS »
...
The first consideration on hearing a heart murmur is to determine
whether the murmur is functional or organic. Certainly, the low-grade
systolic murmurs tend to be functional; if the murmur changes or disappears
on position,... Pictures
... READ EXCERPTS »
...
Tachycardia, like dyspnea, is usually a sign that the tissues are not
getting enough oxygen to meet their demands. To recall a list of causes,
pathophysiology is applied. If tachycardia results from anoxia then
the causes can be developed on... Pictures
... READ EXCERPTS »
...
With few exceptions, the etiologies of cardiac arrhythmias like those
of bradycardia can best be recalled using the mnemonic VINDICATE. The
exceptions are from one pathophysiologic cause: obstruction and
consequent... Pictures
... READ EXCERPTS »
...
Visualizing the conduction system of the heart from its beginning in
the sinus node to its ends in the ventricular muscle, one can develop a list
of the causes of pulse irregularities.
Sinus node. Pulse irregularities associated with
... READ EXCERPTS »
A person with atrial fibrillation has two options; they can remain in atrial fibrillation or restore sinus rhythm. Learn the factors that may have an...
A pacemaker is an implanted device that helps the heart beat more regularly. Learn more about the different kinds of pacemakers and the heart...
A pacemaker is a battery-powered device that sends signals to the heart to help it beat properly. Tune in to find out more about these life-saving...