Investigation of Palpitations

Question 1

1st line investigation in palpitations?

Answer 1

bloods

• Hb (anaemia)
• MCV (B12/folate deficiency, alcohol)
• Us&Es (renal function, potassium etc)
• thyroid function

Question 2

2nd line investigation in palpitations?

Answer 2

ECG
can show ectopics, AF, WPW, heart block etc
can be normal if not having the palpitations at the time

Question 3

what can be used to catch the palpitations if theyre not having them at time of ECG?

Answer 3

can try and trigger it if exercise induced etc
24 hr tape/ambulatory ECG/holter test/R test
- records ECG for 24 hrs
- only good if they have frequent palpitations which will be seen every day
- be aware of “normal” abnormalities

Question 4

what can be done if palpitations are less frequent?

Answer 4

can do 48hr or up to 7 day tracings
- not done too often due to huge amount of data to analyse
event recorder used more often

Question 5

what can be done for very infrequent palpitations (eg every 6 months) without any red flags?

Answer 5

tell patient to get immediate ECG when palpitations come on

either go to A+E, GP or straight to cardiology dpt

Question 6

what can be done if very infrequent palpitations with red flags (syncope etc)?

Answer 6

implantable loop recorder

- records 2.5-3 years and saves any abnormal tracings