Data gathering
- Red flags
- Chest pain, Breathless, Lightheaded, Clammy, LOC, Exertional
- PMH: pre-existing heart disease
- FH: sudden cardiac death
- Abnormal resting ECG
- Others
- Caffeine, anxiety
- Frequency
- Triggers
- SH: alcohol, smoking
- Non-cardiac causes
- Thyrotoxicosis
- Anaemia
- Sepsis
- Examine
- BP, pulse
- Signs of anaemia
- CV examination
- Thyroid examination
Clinical management
- Investigations
- Bloods
- FBC, U+E, LFTs, TFTs, HbA1c, cholesterol
- ECG
- Echo
- If murmur, suspected heart failure or structural heart disease (LBBB, LVH, Q-waves)
- 24hr ECG
- Event recorder (if infrequent symptoms)
- Explanation
- The term ‘palpitations’ is used when we are aware of our heart beating. Common causes: caffeine, smoking, overactive thyroid, anxiety, irregular heart rhythms.
- Treatment
- Ectopics
- <5% but otherwise normal ECG and no structural heart disease
- Reassure, reduce stress/caffeine/alcohol/smoking/drugs
- consider beta-blocker
- DVLA
- If syncope or cardiac cause
- Follow-up / Safety net
- Refer
- SVT
- Atrial flutter, atrial tachycardia
- Ventricular tachycardia
- Ectopics with abnormal ECG or evidence of structural heart disease
- Red flags (unless unstable in which case, admit)