Document type
Clinical pathways
East and North Hertfordshire
Output type
Clinical Pathways


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