- RAG rating
- n/a
- Document type
- Clinical pathways
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Pathways
- Pathway
- Palpitations
Palpitations
Examination and investigation of patient with history of palpitations:
- Cardiovascular and thyroid status examinations. Consider other systems examination depending on patient’s symptoms.
- Record 12 lead ECG
- Bloods- FBC, UEs, TFT, LFT, CRP
RED FLAGS – Refer to A&E
- Palpitations with syncope
- Haemodynamically unstable
- Respiratory distress
Atrial fibrillation on ECG – follow Atrial Fibrillation pathway
Risk stratify patients according to traffic light criteria below:
Moderate/High risk refer to cardiology urgently (high risk should be seen urgently i.e. within 2 weeks)
Low risk: consider benign physiological cause for palpitations - Lifestyle advice Reduction in ETOH/ anxiety management/ signposting to prevention services
Ongoing concern in a low risk patient (NB: if direct access 24h ECG not available, refer to Cardiology outpatient clinic) NB: use appropriate referral form
Things to include in referral letter:
- Urgency of referral
- History of palpitations: nature, time of day, frequency, severity, exacerbating factors, triggers, associated symptoms.
- Relevant past medical history, medication history and family history of sudden death <40 years.
- Examination findings
- Relevant blood results
- ECG findings
Patient information leaflet: Palpitations & Ectopic Beats