Palpitations

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:
- Panic attack
- Anxiety
- Somatic Symptom Disorder
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

See Also

Atrial Fibrillation

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