Palpitations
Contents
Background
- Sensation of rapid or irregular heart rate
Red flags
- Cardiac disease
- Known ECG abnormality
- Syncope/pre-syncope
- Exertional palpitations
- Hypotension or relative hypotension
- Heart failure symptoms
Clinical Features
- Sensation of rapid or irregular heart rate
- Syncope or pre-syncope
- Shortness of breath
- Anxiety
Differential Diagnosis
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
Work-Up
- ECG
- CBC
- BMP
- TSH
- CXR
- Troponin in patients with suspicion for underlying heart disease or failure
- Consider extended electrolytes (Mg/Phos)
- Consider toxicologic work-up if concern for intoxications
Diagnosis
- Thyroid exam
- Careful cardiac exam for murmurs
- Cardiac monitoring
- Consider walk test if palpitations primarily present with exertion
Management
- Etiology specific
Disposition
- Etiology specific
- Consideration for Holter monitoring (or similar) with outpatient cardiologist if clinically stable for discharge home
- Recommend avoidance of stimulants and alcohol pending outpatient follow-up
- Criteria for admission from Management of patients with palpitations: a position paper from the European Heart Rhythm Association[1]

Criteria for the hospitalization of patients with palpitations from Management of patients with palpitations: a position paper from the European Heart Rhythm Association, EP Europace, Volume 13, Issue 7, July 2011, Pages 920–934, https://doi.org/10.1093/europace/eur130