1. Approach to Palpitations
Tom Wallace, MD Cardiac Electrophysiologist CHI St. Vincent Heart Clinic Arkansas

2. Approach to Palpitations
Sinus pauses and heart block
Sinus Tachycardia
Atrial dysrhythmias
Ventricular dysrhythmias

3. Sinus Tachycardia Secondary causes (Stressors) Fever / infection
Volume depletion
Hyperthyroidism
Anemia
Dieting

4. Sinus Tachycardia Inappropriate sinus tachycardia Not common
Difficult to treat

5. Atrial beats that arise from areas of the atria not the sinus node

6. Ventricular beats
right ventricle endocardium
left ventricle epicardium
apex outflow tract

7. Supraventricular Tachycardia
Atrial Tachycardia
Atrial Flutter
Atrial Fibrillation
Accessory Pathway
Wolff Parksinson White
Atrio-Ventricular Reentrant Tachycardia

8. Ventricular Tachycardia
Structurally abnormal hearts
Ischemic cardiomyopathy (scar mediated)
Nonischemic cardiomyopathy
Arrhythmogenic Right Ventricular dysplasia
Structurally normal hearts
Outflow tract origin (right or left ventricle and Aorta)
Long QT syndrome, catecholaminergic VT
Short QT, Brugada Syndrome

9. Diagnostics 12 Lead ECG 24-48 Holter monitoring
30 day event monitoring
Echocardiogram
Exercise stress testing
Electrophysiology Study

10. Treatments Address secondary causes
Beta blocker or calcium channel blockers
Antiarrhythmic medications
Catheter ablation