An implantable loop recorder may be helpful in people with very infrequent but disabling symptoms. This recorder is implanted under the skin on the front of the chest, like a pacemaker. It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.Investigation of heart structure can also be important. The heart in most people with palpitation is completely normal in its physical structure, but occasionally abnormalities such as valve problems may be present. Usually, but not always, the cardiologist will be able to detect a murmur in such cases, and an ultrasound scan of the heart (echocardiogram) will often be performed to document the hearts structure. This is a painless test performed using sound waves and is virtually identical to the scanning done in pregnancy to look at the fetus. Evaluation
A 12-lead electrocardiogram must be performed on every patient complaining of palpitations. The presence of a short PR interval and a delta wave (Wolff-Parkinson-White syndrome) is an indication of the existence of ventricular pre-excitation. Significant left ventricular hypertrophy with deep septal Q waves in I, L, and V4 through V6 may indicate hypertrophic obstructive cardiomyopathy. The presence of Q waves may indicate a prior myocardial infarction as the etiology of the palpitations, and a prolonged QT interval may indicate the presence of the long QT syndrome.Laboratory studies should be limited initially. Complete blood count can assess for anemia and infection. Serum urea, creatinine and electrolytes to assess for electrolyte imbalances and renal dysfunction.
Malignant lesions are aggressive and difficult to eradicate with surgery and have a recurrence rate of 32%. Epidemiology
Granular cell tumors can affect all parts of the body; however, the head and neck areas are affected 45% to 65% of the time. Of the head and neck cases 70% of lesions are located intraorally (tongue, oral mucosa, hard palate). The next most common location that lesions are found in the head and neck area is the larynx (10%). Granular cell tumors are also found in the internal organs, particularly in the upper aerodigestive tract. Vaginal granular cell tumors are generally rare.Breast granular cell tumors arise from intralobular breast stroma and occurs within the distribution of the cutaneous branches of the supraclavicular nerve. As they do follow the innervation of the skin, they may demonstrate skin changes like contraction or shrinkage. Unlike traditional breast cancers, glandular cell tumors are mostly found in the upper inner quadrant of the breast. They can erroneously diagnosed as an invasive ductal carcinoma via ultrasound and mammography, therefore, it is necessary to consider a diagnosis of invasive ductal carcinoma. The usual presentation is of a slow growing behavior, forming a polygonal accumulation of secondary lysosomes in the cytoplasm. Granular cell tumors are typically solitary and rarely larger than three centimeters. However, proliferative growth and development of an ulcer indicates likely malignancy as this type of tumor can be either benign or malignant. Malignancy is rare and constitutes only 2% of all granular cell tumors.