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Minimally invasive approach to the child with palpitations
Kesava Rajagopalan1, James E Potts, Shubhayan Sanatani
1Medtronic of Canada Ltd, Field Clinical Engineer, 305-601 W Broadway, Vancouver, BC, V5Z 4C2, Canada. kevasa.rajagopalan@medtronic.com
Insights
Palpitations in children often cause concern but are usually benign. Evaluating the cause involves history, physical exam, and sometimes monitoring to rule out serious heart conditions.
Area of Science:
- Pediatric Cardiology
- Clinical Evaluation
- Cardiac Diagnostics
Background:
- Palpitations are a frequent referral reason in pediatric cardiology.
- While often benign, palpitations cause significant anxiety for patients and families.
- They can also signal serious underlying heart disease, concerning referring physicians.
Purpose of the Study:
- To outline the diagnostic approach for pediatric palpitations.
- To differentiate between benign and potentially serious causes.
- To review current monitoring technologies for symptom assessment.
Main Methods:
- Emphasis on thorough patient history and physical examination.
- Utilizing diagnostic tools such as cardiac imaging and ambulatory monitoring.
- Comparison of Holter monitoring and event recorders (including implantable loop recorders).
Main Results:
- A comprehensive evaluation is crucial for accurate diagnosis.
- Noncardiac causes are common and should be considered.
- Various monitoring technologies offer distinct advantages for capturing symptomatic events.
Conclusions:
- The primary goal is to distinguish benign palpitations from those indicative of significant heart disease.
- Informed selection of monitoring technology aids in diagnosis and management.
- A systematic approach ensures appropriate care for children experiencing palpitations.
Abstract:
Palpitations are a common reason for referral to a pediatric cardiologist. Although generally benign, palpitations are a significant cause for concern in the individual and their family. Similarly, palpitations may be the initial presentation of significant heart disease, resulting in heightened concern in the referring physician. Although emphasis is usually placed on excluding arrhythmia as the cause for palpitations, there are a variety of noncardiac causes for palpitations. The patient history and physical examination are the key components of the evaluation and guide subsequent investigations. In many cases, an immediate diagnosis cannot be made and additional testing may be required; this often includes further monitoring for episodes, cardiac imaging and ambulatory monitoring. Current technologies for ambulatory monitoring during symptoms include Holter monitoring and a variety of patient-activated event recorders, including implantable loop recorders. Each presents its own unique advantages and disadvantages to aid diagnosis in the management of a child with palpitations. The primary focus for the clinician is to determine whether the etiology is benign in nature or whether there is underlying heart disease that may carry a more serious prognosis.
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