Palpitations
In a palpitations workup, gather and document how episodes start and stop, rate and rhythm, triggers, any ECG captured during symptoms, thyroid and electrolyte results, and the red flags.
Heart and lungs: In these presentations, you often have an ECG, a troponin or a chest X-ray in the sources already.
Key takeaways
- Ask the patient to tap out the rhythm and record whether it was regular.
- Look for an ECG or monitor recording taken during symptoms.
- Record syncope, exertional symptoms and family history explicitly.
What this presentation is
Palpitations are an awareness of the heartbeat. Most causes are benign, and a minority are arrhythmias that need specialist assessment.
A recording made during symptoms is the most useful single source. Without one, the history carries the assessment.
Gather these sources first
- Any ECG or ambulatory monitor recording taken during symptoms
- The resting 12-lead ECG
- Thyroid function, complete blood count and electrolytes
- Echocardiogram reports if done
- Previous cardiology letters
- The medication list, including over-the-counter stimulants
Document these history questions
- Whether episodes start and stop suddenly or gradually
- Rate and regularity, tapped out by the patient
- Duration and frequency of episodes
- Triggers such as exertion, caffeine, alcohol or position
- Associated chest pain, breathlessness or presyncope
- Known heart disease
- Family history of sudden cardiac death at a young age
Record these findings
- Pulse rate and rhythm
- Blood pressure and heart sounds
- ECG rhythm, PR interval, QRS width and corrected QT interval
- Thyroid function and electrolytes
- Monitor findings correlated with symptom diary entries
Ask about these red flags
Record each one as present or absent. Your local pathway decides what happens when one is present.
- Syncope or near syncope with palpitations
- Palpitations during exertion
- Chest pain or breathlessness with episodes
- Known structural heart disease
- Family history of sudden cardiac death at a young age
- An abnormal resting ECG
Put these in the assessment draft
- A description of the episodes in the patient's terms
- The ECG findings, with intervals
- A differential between benign and arrhythmic causes
- The red flags asked about and the answers
- A plan with monitoring, referral and safety-netting advice
How Workup Desk helps
Add the ECG reports, monitor summaries, lab results and letters to the workspace. Ask whether any recording in the sources coincides with a symptom.
Draft the assessment or the cardiology referral and edit it. The chat names the report behind each interval it quotes.
Frequently asked questions
Why record the corrected QT interval?
The QT interval varies with heart rate, so it is compared after correction. A prolonged corrected QT changes the differential and matters for some medicines.
General guidance on what to gather and document, not advice about any individual patient. Local guidelines and your clinical judgment govern.