PALPITATIONS (ASSESSMENT (Thorough history (Examination ( (Check heart…
Onset, duration, frequency, nature of palpatations.
Associated symptoms - breathlessness, chest pain, syncope or near syncope.
Hx of HD that could predispose to serious arrhythma - IHD, HF, Cardiomyopathy, valve disease.
Anyd rugs that can cause palpitations.
Family Hx of sudden caridac death before 40years of age.
Lifestyle - alcohol, caffeine, smoking, cocaine, herion, amphetamines, ecstasy & cannabis.
Check heart rate and rhythm, and measure blood pressure — if there are signs of haemodynamic instability.
Check for murmurs suggesting valve disease.
Assess for signs of heart failure such as raised jugular venous pressure (JVP), lung crepitations, and peripheral oedema.
Assess for signs of thyrotoxicosis, anaemia, or other co morbidity such as sepsis.
For people with current palpitations, take an electrocardiogram (ECG) immediately, including a long rhythm strip if possible. For people with a history of palpitations, arrange an ECG (the urgency depending on clinical judgement)
Patients awaiting referral but do not required admission - FBC, U&E's, TFT's, LFT's, HbA1C. Lifestyle advice - avoid stress, caffeine, alcohol, smoking and drugs. DVLA advice re driving.
Admit to hospital
Arrange emergency admission for a person with current palpitations and:
Ventricular tachycardia (VT).
Persistent supraventricular tachycardia (SVT).
Haemodynamic instability (hypotension and/or tachycardia).
Syncope or near syncope.
Family history of sudden cardiac death under the age of 40 years
Refer to cardiology clinic
Refer to cardiology, the urgency depending on clinical judgement, people with:
Supraventricular tachycardia (SVT) terminated by the Valsalva manoeuvre or carotid sinus massage.
Ventricular extrasystoles (ectopics) where:
Underlying heart disease is suspected from the clinical assessment and/or electrocardiogram (ECG).
Extrasystoles are frequent or ventricular tachycardia is suspected.
The term palpitations is used to describe an abnormally perceived heartbeat. This could include a feeling of the heart racing, an irregularity, or an unusual pounding sensation.
Cardiac arrhytmias, structural heart disease, psychomatic disorders, systemic causes, drugs.