Assessment of palpitations

In certain situations urgent diagnosis and treatment are indicated. Patients found to be in a sustained tachycardia (defined as tachycardia lasting >30 seconds) should be triaged to an appropriate setting, such as the emergency department, and connected to a cardiac monitor. Oxygen saturation and blood pressure should be monitored and appropriate resuscitation given if required. Monitoring of urine output should also be considered, especially if the patient is haemodynamically unstable. An immediate 12-lead ECG should be performed. The treatment given will depend on the arrhythmia diagnosed.

It is often the clinician's first instinct to terminate the arrhythmia before obtaining an ECG; however, unless the patient is haemodynamically unstable, there is almost always enough time to perform a 12-lead ECG, which will be useful in diagnosis and subsequent management.

Palpitations associated with syncope are particularly worrying as they are more likely to be associated with malignant arrhythmias such as ventricular tachycardia and should be urgently evaluated.