The Curbsiders Internal Medicine Podcast #320 Palpitations with Dr. Joshua Cooper
Feb 7, 2022
Dr. Joshua Cooper, director of cardiac electrophysiology at Temple University Hospital, talks about palpitations, emphasizing the importance of properly characterizing them and recognizing red flag symptoms. They discuss the diagnosis of palpitations in young patients, the danger of prematurely diagnosing anxiety, and the importance of recognizing abnormal P-waves. They also touch on the workup for tachycardia and the need to validate patients' symptoms and refer to specialists.
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Clarify What Patients Mean By Palpitations
- Ask patients to describe palpitations in different words and have them tap or clap the rhythm.
- Use onset, offset, and duration to distinguish sustained tachycardia from brief ectopic beats.
A Normal ECG Doesn’t Rule Out Arrhythmia
- A normal office ECG is only a 10-second snapshot and often misses symptomatic arrhythmias.
- Don’t assume a normal ECG rules out cardiac causes or that symptoms are anxiety.
Treat Syncope With High Concern
- Treat syncope or near-syncope during palpitations as a red flag requiring urgent evaluation.
- Loss of consciousness suggests very rapid tachycardia or high-risk arrhythmia and raises acuity.