What are Emergency Room (ER) precautions for palpitations?

From the Guidelines

For palpitations in the ER, the primary precautions are immediate ECG monitoring, establishing IV access, administering oxygen if needed, and performing blood tests, including electrolytes, thyroid function, and cardiac enzymes. The most recent and highest quality study 1 provides guidance on the management of patients with valvular heart disease, including those with mitral valve prolapse (MVP), which can cause palpitations. Some key points to consider when evaluating a patient with palpitations in the ER include:

• Immediate ECG monitoring to assess heart rhythm and rate
• Establishing IV access for potential medication administration
• Administering oxygen if needed, based on oxygen saturation levels
• Performing blood tests, including electrolytes, thyroid function, and cardiac enzymes If palpitations are due to supraventricular tachycardia (SVT), trying vagal maneuvers first, such as the Valsalva maneuver or carotid sinus massage, is recommended 1. For atrial fibrillation with rapid ventricular response, administering rate-controlling medications like metoprolol or diltiazem is recommended 1. For ventricular tachycardia, performing immediate synchronized cardioversion if unstable, or considering amiodarone if stable, is recommended 1. These precautions aim to identify the underlying cause of palpitations, stabilize the patient, and prevent potential complications. Continuous cardiac monitoring is crucial as palpitations can indicate serious arrhythmias, and prompt intervention can prevent progression to more severe cardiac events 1. In patients with MVP and palpitations, therapy with beta blockers may be effective in controlling symptoms, and cessation of stimulants such as caffeine, alcohol, and cigarettes may also be beneficial 1. Overall, the management of palpitations in the ER requires a thorough evaluation and prompt treatment to prevent complications and improve patient outcomes.

From the Research

Emergency Room Precautions for Palpitations

• The approach to palpitations in the emergency room (ER) involves a detailed history, physical examination, and electrocardiogram (ECG) to yield a probable diagnosis 2.
• Emergency physicians (EPs) perceive palpitations as a common but generally benign chief complaint, and their clinical approach can be classified into themes such as risk stratification, diagnostic categorization, algorithmic management, and case-specific gestalt 3.
• The evaluation of palpitations in the ER may involve limited laboratory testing, ambulatory ECG monitoring, and cardiology referral 2.
• In some cases, patients with palpitations may require admission to an inpatient setting to complete the diagnostic workup, especially if there are signs of hemodynamic compromise 4.
• The disposition decisions for patients with palpitations in the ER are influenced by factors such as the presence of a serious diagnosis, perceived need for further cardiac testing or monitoring, presence of key associated symptoms, and request of other physician or patient desire 3.
• A study on the evaluation and outcomes of patients with palpitations found that the etiology of palpitations can often be diagnosed with a simple initial evaluation, and psychiatric illness accounts for the etiology in nearly one third of all patients 5.