What elements should be included in a concise History of Present Illness (HPI) paragraph template for palpitations?

Concise HPI Paragraph Template for Palpitations

A comprehensive HPI paragraph for palpitations should include the patient's description of sensation, onset, duration, frequency, triggers, associated symptoms, relieving factors, and impact on quality of life.

Essential Elements to Include

Patient's Description of Sensation

• Specific description of palpitations: racing, fluttering, pounding, skipping beats, or irregular heartbeat 1, 2
• Location of sensation (chest, neck, throat)

Temporal Characteristics

• Onset (sudden vs. gradual)
• Duration of episodes (seconds, minutes, hours)
• Frequency (daily, weekly, monthly)
• Pattern (regular vs. irregular)

Triggers and Context

• Activity during onset (rest, exertion, position changes)
• Specific triggers:
  • Emotional stress
  • Physical activity/exercise
  • Consumption of caffeine, alcohol, or other stimulants
  • Medication use or changes
  • Illicit drug use 3, 2

Associated Symptoms

• Presyncope: dizziness, lightheadedness, feeling faint 1
• Syncope (loss of consciousness) 1
• Chest pain or discomfort 1
• Dyspnea (shortness of breath) 1, 3
• Fatigue or decreased exercise tolerance 1
• Diaphoresis (sweating)

Relieving Factors

• What makes symptoms better (rest, position changes, medications)
• What makes symptoms worse

Impact on Daily Life

• Effect on sleep 1
• Effect on work 1
• Effect on quality of life 2

Past Medical History Relevance

• History of cardiac disease 1
• History of arrhythmias 1
• History of thyroid disease 1
• History of anxiety or other psychiatric conditions 2
• Family history of cardiac conditions or sudden death 1

Sample Template Format

"[Age]-year-old [gender] presents with palpitations described as [specific sensation] in the [location]. Symptoms began [timeframe] and typically last [duration]. Episodes occur [frequency] and are [pattern]. Palpitations are triggered/worsened by [triggers] and improved with [relieving factors]. Associated symptoms include [associated symptoms]. Patient [does/does not] report syncope, presyncope, chest pain, or shortness of breath. Symptoms impact daily life by [impact]. Relevant past medical history includes [relevant PMH]. Family history is [relevant family history]."

Clinical Pearls

• Always document the presence or absence of syncope, presyncope, and chest pain as these may indicate more serious underlying conditions 1
• Note whether palpitations occur at rest or with exertion, as exertional palpitations may suggest structural heart disease 1, 4
• Document any medication use, including over-the-counter medications and supplements, as these can be common causes of palpitations 3
• Include the impact on quality of life as this helps determine the urgency and extent of evaluation 2