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Predecir arritmia cardiaca en pacientes con palpitaciones

Does This Patient With Palpitations Have a Cardiac Arrhythmia?

This systematic review by the  Rational Clinical Examination found that an arrhythmia was more likely (LR > 2) if that patient has:

  • A history of cardiac disease (likelihood ratio [LR], 2.03; 95% CI, 1.33-3.11)
  • Palpitations affected by sleeping (LR, 2.29; 95% CI, 1.33-3.94)
  • Palpitations while at work (LR, 2.17; 95% CI, 1.19-3.96)

A arrhythmia was less likely (LR < 0.5) if that patient has:

  • A known history of panic disorder (LR, 0.26; 95% CI, 0.07-1.01)
  • Palpitations lasting less than 5 minutes (LR, 0.38; 95% CI, 0.22-0.63)

Additional findings that need further discussion are:

  • Description by the patient of an irregular heart rate was an independent predictor of a cardiac arrhythmia(PMID: 8629647). The authors of the systematic review did not conclude this finding was helpful because the likelihood ratio, while significant, was within 0.5 to 2.0.
  • An increased number of symptoms suggested psychiatric causes in the univarate, but not multivariate  analysis of Weber  (PMID: 8629647). This finding is part of a theme in general that the more symptoms are present the more likely there is an underlying psychiatric diagnosis in the evaluation of syncope (PMID: 17397948) and symptoms in general in primary care (PMID: 7987511).

Citation:

Thavendiranathan, P., Bagai, A., Khoo, C., Dorian, P., & Choudhry, N. (2009). Does This Patient With Palpitations Have a Cardiac Arrhythmia? JAMA: The Journal of the American Medical Association, 302 (19), 2135-2143 DOI: 10.1001/jama.2009.1673 – PMID 19920238

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