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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Cardiac Arrhythmia
David L. Simel
Acceptable reference standards are clinical event monitors, intermittent event recorders,...

Topics Discussed: cardiac arrhythmia, criterion standard comparisons (diagnostic tests), holter electrocardiography, likelihood ratio, make the diagnosis, palpitations

Excerpt: "About 16% of general medical patients report that they have palpitations.1 Within this group of symptomatic patients, the pretest probability of any cardiac arrhythmia is 39%. Important risk factors are age, sex, family history of palpitations, history of panic disorder, and history of prior cardiac disease. Medications should be reviewed for all patients with palpitations. Having the patient tap out his or her perceived rhythm or to choose from cadences tapped out by the physician may help in identifying the regularity and speed of the palpitations...."
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