Palpitations: Evaluation, Management, and Wearable Smart Devices.

Palpitations are a common symptom described by patients as a feeling of a racing or fluttering heart, a pounding chest, irregular or skipped heartbeats, or a pounding sensation in the neck. They are associated with a low mortality rate; however, recurrent palpitations have been shown to impair quality of life and increase health care use. Common triggers are cardiac disorders, endocrine and metabolic disorders, medication or illicit drug use, or psychosomatic disorders.

Managing Selected Chronic Conditions in Hospitalized Patients.

The management of chronic illnesses should continue during hospitalization. Some chronic conditions require immediate intervention, whereas intensification of therapy for other conditions may be delayed until after discharge. Factors such as pain, anxiety, poor sleep hygiene, and concurrent illness can result in a transient elevation of blood pressure.

Cardiovascular Disease: Inflammatory and Infectious Heart Conditions.

Acute pericarditis, the most common inflammatory heart condition, typically is caused by viral infections. Patients have sharp chest pain that improves when leaning forward. Electrocardiogram typically shows widespread ST-segment elevation; echocardiogram may show pericardial effusion; and levels of inflammatory markers may be elevated.

Cardiovascular Disease: Other Common Arrhythmias.

Premature atrial contractions (PACs) occur in nearly all individuals. Although typically asymptomatic, they can cause palpitations. PACs previously were considered benign, but there is increasing recognition that frequent PACs are associated with developing atrial fibrillation.

Cardiovascular Disease: Anticoagulation Therapy for Atrial Fibrillation.

Patients with atrial fibrillation (AF) should receive anticoagulation with warfarin or direct oral anticoagulants (DOACs) if the CHADS-VASc (Congestive heart failure, Hypertension, Age 75 years or older [doubled], Diabetes, prior Stroke or transient ischemic attack or thromboembolism [doubled], Vascular disease, Age 65 to 74 years, Sex category) score is at least 2 in men or 3 in women. Antiplatelet therapy is not recommended. DOACs typically are the first-line therapy.

Cardiovascular Disease: Atrial Fibrillation and Atrial Flutter.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, with lifetime rates of 21% to 33%. There are numerous risk factors, including older age, hypertension, coronary disease, obstructive sleep apnea, diabetes, and others. Patients engaging in lifelong high-endurance exercise also have increased risk.

Thrombocytopenia: Evaluation and Management.

Thrombocytopenia is a platelet count of less than 150 × 103 per μL and can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping. Patients with a platelet count greater than 50 × 103 per μL are generally asymptomatic. Patients with platelet counts between 20 and 50 × 103 per μL may have mild skin manifestations such as petechiae, purpura, or ecchymosis.

Otolaryngeal and Oropharyngeal Conditions: Common Ear Conditions.

Ear pain (otalgia) is a common reason for visits to family physician offices and emergency departments. Otalgia is primary when the pathology originates from the ear, and is secondary for disease processes associated with otalgia and an ear examination with normal findings. The most common diagnosis related to otalgia in children and adults is acute otitis media (AOM).

Otolaryngeal and Oropharyngeal Conditions: Common Nontraumatic Dental Conditions.

Dental and oral health conditions are widespread in the US population. Among children and teenagers, 46% have dental cavities; among adults, more than 90% have cavities and 46% have periodontal disease. In 2015, more than $117 billion was spent on dental care in the United States, with a significant share delivered in emergency departments (EDs).

Otolaryngeal and Oropharyngeal Conditions: Temporomandibular Disorders.

Temporomandibular disorders (TMDs) is a collective term for a group of heterogeneous musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ) complex, masticatory muscles, and surrounding osseous structures. TMDs affect 5% to 12% of the US population, with a peak incidence at ages 45 to 65 years. Common clinical manifestations include facial pain, ear pain, headache, TMJ discomfort, and adventitious sounds.

Otolaryngeal and Oropharyngeal Conditions: Dysphonia.

Dysphonia is any alteration of voice quality or vocal effort that impairs communication and affects quality of life. In patients with dysphonia, voice qualities often are described as tremulous, hoarse, strained, or raspy, with altered pitch, breathiness, or vocal fatigue. Dysphonia is a sign of an underlying disease process.

Syncope: Evaluation and Differential Diagnosis.

Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs.

Diagnosis and treatment of temporomandibular disorders.

Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular.

Common questions about outpatient care of premature infants.

Preterm births (deliveries before 37 weeks' gestation) comprise 12% of all U.S. births and are responsible for onethird of all infant deaths.

Early recognition and management of sepsis in adults: the first six hours.

Sepsis is a complication of severe infection characterized by a systemic inflammatory response. Mortality rates from sepsis range between 25% to 30% for severe sepsis and 40% to 70% for septic shock. The clinical presentation of sepsis is highly variable depending on the etiology.

Thrombocytopenia.

Thrombocytopenia is defined as a platelet count of less than 150 × 10(3) per µL. It is often discovered incidentally when obtaining a complete blood count during an office visit. The etiology usually is not obvious, and additional investigation is required.

Evaluation of syncope.

Syncope is a transient and abrupt loss of consciousness with complete return to preexisting neurologic function. It is classified as neurally mediated (i.e.