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.
- 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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