Palpitations are a difficult area to cover as there are so many potential ECG abnormalities, and so much detail you could go into about treating them. Luckily, EnlightenMe again comes to the rescue for the generic areas. We'll cover each common abnormality in a bit more detail eventually!
Palpitations have an underlying cardiac cause in 43%, are due to anxiety in 31% and have no specific attributable cause in 16% of patients. Worryingly, they're more likely to have a "proper" cause if they occur at work, whilst sleeping, or in the presence of known cardiac disease!
Establish the presence of symptoms which may indicate an underlying cause:
Chest pain (in the absence of or preceding palpitations)
History of structural heart disease
Family history of sudden cardiac death
Electrolyte measurement (potassium, calcium and magnesium)
Management after rhythm or rate control
At risk of life threatening arrhythmia e.g. those with a previously recorded episode of VT
Adverse symptoms or signs during the palpitations.
Implanted cardiac devices suspected of malfunction.
Family history of sudden death (eg, Brugada Syndrome).
Require admission for investigation or treatment of an underlying cause or illness
No protocols for follow up