Palpitation (GUIDELINES)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • Highland HSCP 
  • Primary and Secondary Care

Palpitations are extremely common and often noticed only during quiet activity, e.g. lying in bed, sitting.  The vast majority of short-lived palpitations are benign and reassurance without a monitor is sufficient.  Previous audit of NHSH arrhythmia monitors showed that only 4% reported significant arrhythmia requiring consultant advice.  

Perform 12 lead ECG 

History:
  • Skipped beats
  • ­Slow pounding
  • ­Thumping beats
  • ­Short episodes of fluttering (< 10 s)

AND normal ECG

AND absence of heart disease (based on history, clinical evidence or previous echo)

AND no family history of sudden cardiac death under age 50 years

Reassurance without monitor
If a clinician feels there is a clinical scenario that they are unable to confidently manage, then referral for advice is always appropriate 

History:
  • ­Recurrent fast or prolonged palpitations
  • Palpitations with associated symptoms (e.g. dyspnoea, chest discomfort, dizzy)

OR abnormal ECG (e.g. previous MI, LVH, ST changes, abnormal T wave inversion, consider echo)

OR presence of heart disease (based on history, clinical evidence or previous echo)

Undertake GP-based monitor or refer for direct access monitor via SCI gateway.  If there is a significant arrhythmia then advice will be provided by a cardiologist.                        
If a clinician feels there is a clinical scenario that they are unable to confidently manage, then referral for advice is always appropriate.  

History:
  • ­Associated syncope or near syncope
  • ­Palpitations during exercise

OR known high risk heart disease (e.g. LV impairment, aortic stenosis, long QT interval, WPW pattern, heart block)

OR family history of sudden cardiac death under age 50 years or inherited cardiac conditions (e.g. HCM, LQTS)

OR previously proven serious arrhythmia with exacerbation of symptoms

Referral to cardiology clinic via SCI gateway 
If a clinician feels there is a clinical scenario that they are unable to confidently manage, then referral for advice is always appropriate 

Abbreviation  Meaning
ECG  Electrocardiogram
U&Es  Urea & Electrolytes

Editorial Information

Last reviewed: 17/02/2025

Next review date: 29/02/2028

Version: 3

Reviewer name(s): Dr Jonathan Watt, Consultant Cardiologist , Dr Sarah Birkby, Consultant Cardiologist .

Document Id: TAM438