Clinical investigations from the RACP

The patient with palpitations: cardiac, systemic or psychosomatic?

Liang-han Ling, Peter Kistler
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Palpitations are a common complaint and many affected patients can be managed in primary care. Careful clinical assessment and the judicious use of investigations to distinguish between benign and serious causes are needed.

Key Points

  • During the initial consultation, careful history taking, physical examination and a baseline ECG often reveal the likely cause of palpitations to be cardiac, systemic or psychosomatic.
  • Concerted attempts should be made by both doctor and patient to obtain an electrocardiographic recording during palpitations, as this provides the basis for a definitive diagnosis.
  • Echocardiography is essential to evaluate for the presence of structural heart disease.
  • Specific investigations should be performed if there is clinical suspicion of an underlying systemic condition.
  • Referral of patients with documented arrhythmias to a cardiac electrophysiologist is warranted, as many may be treated effectively with catheter ablation; however, other patients may be managed by their GP or referred to a general cardiologist for further evaluation.
  • Patients with benign palpitations due to isolated ectopy, anxiety or psychosomatic conditions should be treated with reassurance and counselling.

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