From the Guidelines
Initial investigations for a patient presenting with palpitations should include a comprehensive history, physical examination, and targeted diagnostic tests, starting with a 12-lead electrocardiogram (ECG) to assess for arrhythmias, conduction abnormalities, or structural heart disease 1. The workup should begin by assessing the patient's symptoms, including the pattern, duration, and frequency of palpitations, as well as any potential triggers, as described in the clinical history and physical examination section of the guidelines for the management of patients with supraventricular arrhythmias 1.
Key Investigations
- Blood tests, including complete blood count, electrolytes (particularly potassium, magnesium, and calcium), thyroid function tests, and cardiac biomarkers if cardiac ischemia is suspected, are essential to identify potential underlying causes of palpitations 1.
- A 24-hour or longer Holter monitor or event recorder should be considered if the palpitations are intermittent, as these devices can capture arrhythmias during symptomatic episodes 1.
- Echocardiography may be warranted to evaluate cardiac structure and function, especially if there are signs of structural heart disease, as recommended in the guidelines for the management of patients with atrial fibrillation 1.
- Additional tests like exercise stress testing might be appropriate for palpitations triggered by exertion. These investigations help identify the underlying cause of palpitations, which can range from benign conditions like anxiety or caffeine consumption to serious cardiac arrhythmias requiring specific treatment.
Considerations
- The choice of investigations should be guided by the patient's clinical presentation, medical history, and physical examination findings.
- The guidelines for the management of patients with supraventricular arrhythmias and atrial fibrillation provide a framework for the evaluation and management of patients with palpitations 1.
From the Research
Initial Investigations for Palpitations
The initial investigations for a patient presenting with palpitations include:
- A detailed history and physical examination to identify potential causes and assess the patient's overall health 2, 3, 4, 5
- A 12-lead electrocardiogram (ECG) to evaluate the heart's rhythm and identify any potential abnormalities 2, 6, 3, 4, 5
- Laboratory tests, such as blood work, to rule out underlying conditions that may be contributing to the palpitations 2, 5
Additional Investigations
If the initial evaluation results are negative, or if the patient is experiencing frequent or poorly tolerated palpitations, additional investigations may be necessary, including:
- Ambulatory ECG monitoring, such as a Holter monitor, to capture episodes of palpitations and evaluate the heart's rhythm over a longer period of time 2, 6, 4
- Electrophysiological studies to evaluate the heart's electrical activity and identify potential arrhythmias 2, 3
- Echocardiography to evaluate the heart's structure and function 2
- Treadmill exercise stress test to evaluate the heart's response to exercise and identify potential arrhythmias 2
Specialized Management
A specialized management approach, including early ECG recording and individualized management, can lead to a high diagnostic accuracy in patients presenting with palpitations, with cardiac arrhythmia being the cause of palpitations in over 80% of cases 6