Alex Ja McLellan1, Jonathan M Kalman2. 1. MBBS, PhD, Cardiology Department, Royal Melbourne Hospital, Vic; Cardiology Department, St Vincent@s Hospital Melbourne, Vic; Baker Heart @ Diabetes Institute, Vic. 2. MBBS, PhD, Cardiology Department, Royal Melbourne Hospital, Vic; Cardiology Department, St Vincent@s Hospital Melbourne, Vic; Baker Heart @ Diabetes Institute, Vic; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Vic.
Abstract
BACKGROUND: Palpitations are one of the most common presentations to general practice. While they are usually benign, they may be associated with an adverse prognosis. OBJECTIVE: This article presents a systematic approach to the patient with palpitations and addresses considerations of aetiology, history and examination; appropriate diagnostic work-up; cardiology/electrophysiology referral and management strategies. DISCUSSION: Not all palpitations are due to arrhythmia, and because of the transitory nature of palpitations, the work-up will usually be performed between episodes. Direction from history, examination and 12-lead electrocardiography will guide further investigations and will often include an echocardiogram and ambulatory electrocardiographic monitoring. The intensity of ambulatory electrocardiographic monitoring and diagnostic work-up will be dictated by the frequency, nature and severity of symptoms, and will sometimes require incorporation of new technologies and electrophysiology referral. Ultimately, management must be tailored on a case-by-case basis depending on the cause of palpitations and symptom severity.
BACKGROUND: Palpitations are one of the most common presentations to general practice. While they are usually benign, they may be associated with an adverse prognosis. OBJECTIVE: This article presents a systematic approach to the patient with palpitations and addresses considerations of aetiology, history and examination; appropriate diagnostic work-up; cardiology/electrophysiology referral and management strategies. DISCUSSION: Not all palpitations are due to arrhythmia, and because of the transitory nature of palpitations, the work-up will usually be performed between episodes. Direction from history, examination and 12-lead electrocardiography will guide further investigations and will often include an echocardiogram and ambulatory electrocardiographic monitoring. The intensity of ambulatory electrocardiographic monitoring and diagnostic work-up will be dictated by the frequency, nature and severity of symptoms, and will sometimes require incorporation of new technologies and electrophysiology referral. Ultimately, management must be tailored on a case-by-case basis depending on the cause of palpitations and symptom severity.