History

Presenting pattern

Pattern overview

OPQRST

O onset

P provocation and palliation

Q quality

R region and radiation

S severity

T timing

Associated symptoms

Associated symptoms cluster

Prior episodes and baseline

Baseline comparison

Context and triggers

Contextual factors

Rhythm capture history

Prior rhythm documentation

Alarm Features

Immediate life threats

High risk presentations

Vital sign danger thresholds

High risk vitals

High risk history triggers

High risk history

High risk ECG features

ECG red flags

Escalation triggers

Escalation criteria

Medications

Medication reconciliation

Current medications

Arrhythmogenic medications

Medication risk exposures

Recent changes and adherence

Medication course

Drug interactions and contraindications

Interaction hazards

Diet

Stimulants and hydration

Dietary contributors

Alcohol and withdrawal

Alcohol related patterns

Electrolyte linked intake

Electrolyte related factors

Review of Systems

Cardiopulmonary

Cardiopulmonary symptoms

Neurologic

Neurologic symptoms

Endocrine and systemic

Systemic symptoms

Bleeding and clot symptoms

Thrombosis and bleeding signals

Collateral History and Family History

Collateral source

Collateral reliability

Family cardiac history

Familial cardiovascular conditions

Social support and follow up reliability

Follow up feasibility

Risk Factors

Cardiac and arrhythmia risk

Cardiac risk factors

Thromboembolism risk

VTE risk factors

Substance and exposure risk

Exposures

Special populations

Population modifiers

Differential Diagnosis

Life threatening

Life threatening causes

Common

Common causes

Less common

Less common causes

Past Medical History

Cardiac history

Cardiac conditions

Structural disease and procedures

Structural and procedural history

Non cardiac contributors

Relevant comorbidities

Physical Exam

General and hemodynamics

Global assessment

Cardiovascular

Cardiac exam

Respiratory

Lung exam

Volume status

Volume assessment

Neurologic and stroke screen

Neurologic assessment

Lab Studies

Core labs and rationale

Essential labs

Cardiac biomarkers

Myocardial injury testing

Endocrine and metabolic

Endocrine evaluation

Coagulation and anticoagulant context

Coagulation context

Limitations and pitfalls

Interpretation pitfalls

Imaging

Scoring Systems

Decision tools for palpitations context

MRI

MRI indications

MRI limitations

CT

CT indications

CT safety considerations

Ultrasound

POCUS applications

Ultrasound limitations

Special Tests

Bedside maneuvers and monitoring

Bedside options

Rhythm capture strategies

Rhythm documentation

ECG

Indications and timing

ECG workflow

Rhythm diagnosis patterns

Narrow complex tachycardia

Wide complex tachycardia

High risk patterns

ECG danger patterns

AV conduction and brady features

Conduction abnormalities

Assessment

Severity stratification

Stability determination

Working diagnosis framing

Rhythm based diagnosis

Alternative diagnoses and mimics

Mimics and contributors

Plan

First 5 minutes

Immediate workflow

Unstable tachyarrhythmia pathway

Unstable management

Stable regular narrow complex SVT

SVT stable management

Atrial fibrillation or flutter with RVR

Rate control strategy

Rhythm control considerations local protocol dependent

Wide complex tachycardia stable

Wide complex stable approach

Electrolyte correction

Electrolyte optimization

Anticoagulation considerations

Stroke prevention framework

Reassessment loop

Reassessment cadence

Disposition

ICU and monitored care

ICU criteria

Monitored admission criteria

Observation pathway

Observation candidates

Discharge criteria

Discharge requirements

Follow up timing

Follow up plan

Discharge Instructions

Copy discharge instructions

Patient instructions

References

Guidelines and tools

Evidence sources