Anxiety is the commonest cause for palpitations. First rule out Anemia, Hyperthyroidism, LVH and Arrhythmias. Hyperthyroidsm, LVH and Arrythmias. Palpate the pulse (during an attack if possible) for tachycardias and arrhythmias. If pulse rate is > 90/ min, look for thyroid enlargement. Then ausculate the heart for murmurs and look for heaving apex beat of left ventricular hypertrophy. Tab. ATIVAN 1mg x 2-3 times/ day (Tansquiliser) or Tab. ALPRAZOLAM 0.25mg x 2-3 times/ day Tab. CIPLAR 10mg tds (Propranolol) Santevini 2 tsp bd (Tonic with Bplex) If pale, Cap. Autrin 1 OD x 2 months (Iron) Instructions: Avoid excess of tea and coffee. Avoid alcohol and smoking. Avoid mental strain. If no response to treatment, Serum T3, T4 and T.S.H – To rule out Thyrotoxiciosis. ECG and Holter moniter test – to rule out Arrhythmias. If Diabetic, rule out Hypoglycemia. If pulse is normal and heart is normal, then palpations are due to anxiety and will respond to Transquilisers and Beta-blockers. If palpitations are due to left ventricular hypertrophy, explain to the patient that the forceful beat is going to persist and he should learn to accept it. Syp. Santevini Cap. Autrin CIPLAR ALPRAZOLAM ATIVAN |