Approach to palpitations

Abstract

BackgroundPalpitations are one of the mostcommon presentations to generalpractice. While they are usually benign,they may be associated with an adverseprognosis.ObjectivesThis article presents a systematicapproach to the patient with palpitationsand addresses considerations ofaetiology, history and examination;appropriate diagnostic work-up;cardiology/electrophysiology referraland management strategies.DiscussionNot all palpitations are due toarrhythmia, and because of thetransitory nature of palpitations, thework-up will usually be performedbetween episodes. Direction fromhistory, examination and 12-leadelectrocardiography will guide furtherinvestigations and will often includean echocardiogram and ambulatoryelectrocardiographic monitoring.The intensity of ambulatoryelectrocardiographic monitoring anddiagnostic work-up will be dictated bythe frequency, nature and severity ofsymptoms, and will sometimes requireincorporation of new technologies andelectrophysiology referral. Ultimately,management must be tailored on acase-by-case basis depending onthe cause of palpitations andsymptom severity