From the Guidelines
For a 73-year-old female presenting with palpitations for 2 days, I recommend a comprehensive assessment including vital signs, cardiac examination, and an ECG to identify potential arrhythmias, as the most recent and highest quality study suggests that the diagnosis of AF requires confirmation by ECG recording 1. The initial evaluation should characterize the pattern of the arrhythmia, determine its cause, and define associated cardiac and extracardiac factors pertinent to the etiology, tolerability, and management.
- A thorough history will result in a well-planned, focused workup that serves as an effective guide to therapy.
- The physical examination may suggest AF on the basis of irregular pulse, irregular jugular venous pulsations, and variation in the intensity of the first heart sound or absence of a fourth sound heard previously during sinus rhythm.
- Laboratory tests should include complete blood count, electrolytes (especially potassium, magnesium, and calcium), thyroid function tests, and cardiac enzymes if chest pain is present, as suggested by the guidelines for the management of patients with atrial fibrillation 1.
- Initial management depends on findings but may include rate control with beta-blockers (such as metoprolol 25-50mg twice daily) or calcium channel blockers (diltiazem 120-360mg daily) if atrial fibrillation is detected.
- For significant arrhythmias, consider cardiology consultation for potential anticoagulation assessment using the CHA₂DS₂-VASc score, as recommended by the guidelines 1.
- Document onset, duration, associated symptoms (dizziness, chest pain, shortness of breath, syncope), and aggravating/alleviating factors, as emphasized in the guidelines for the management of patients with atrial fibrillation 1. If initial workup is negative but symptoms persist, consider Holter monitoring for 24-48 hours or event monitoring for intermittent symptoms, as suggested by the guidelines for the management of patients with atrial fibrillation 1.
From the FDA Drug Label
Clinical Studies Prolongation of Time to Recurrence of Symptomatic Atrial Fibrillation/ Flutter Sotalol AF has been studied in patients with symptomatic AFIB/AFL in two principal studies, one in patients with primarily paroxysmal AFIB/AFL, the other in patients with primarily chronic AFIB.
The diagnosis for a 73-year-old female presenting with palpitations (abnormal heart rhythms) for 2 days cannot be determined from the provided information. The text only discusses the use of sotalol in patients with symptomatic AFIB/AFL, but does not provide diagnostic criteria or guidelines for diagnosing abnormal heart rhythms. 2
From the Research
Diagnosis of Palpitations in a 73-year-old Female
The diagnosis of palpitations in a 73-year-old female presenting with abnormal heart rhythms for 2 days involves several steps, including:
- A thorough history and physical examination to identify potential causes of palpitations 3, 4, 5
- A 12-lead electrocardiogram (ECG) to evaluate the heart's rhythm and identify any potential cardiac causes 4, 5, 6
- Laboratory tests to rule out non-cardiac causes of palpitations, such as thyroid disorders or anemia 3
Diagnostic Tests
Additional diagnostic tests may be ordered based on the results of the initial evaluation, including:
- Holter monitor or event monitor to record the heart's rhythm over a period of time 3, 4
- Transtelephonic electrocardiographic monitor to record the heart's rhythm during symptoms 3
- Treadmill exercise stress test to evaluate the heart's function during exercise 3
- Echocardiography to evaluate the heart's structure and function 3
- Electrophysiologic studies to evaluate the heart's electrical system 3, 4, 7
Considerations in the Elderly
In elderly patients, it is essential to consider the potential for cardiac and non-cardiac causes of palpitations, including psychiatric disorders 5. A detailed medication history is also crucial, as certain medications can cause palpitations 5. The diagnostic approach should be tailored to the individual patient's needs and risk factors, with a focus on identifying potential life-threatening causes of palpitations 5, 6.