• Alex Ja McLellan and Jonathan M Kalman.
• MBBS, PhD, Cardiology Department, Royal Melbourne Hospital, Vic; Cardiology Department, St Vincent@s Hospital Melbourne, Vic; Baker Heart @ Diabetes Institute, Vic.
• Aust J Gen Pract. 2019 Apr 1; 48 (4): 204-209.

BackgroundPalpitations are one of the most common presentations to general practice. While they are usually benign, they may be associated with an adverse prognosis.ObjectiveThis 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.DiscussionNot 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.

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