Palpitations

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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

Evaluation

Work-Up

  • ECG
  • CBC
  • Chem
  • TSH
  • CXR
  • Troponin in patients with suspicion for underlying heart disease or failure
  • Consider extended electrolytes
  • 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

See Also