Diagnosis

• history and examination
• ECG - occasionally may demonstrate evidence of pre-excitation or QT prolongation, ventricular hypertrophy or previously myocardial infarction
• if diagnosis is not evident from the history and examination and 12-lead ECG
  • the intensity and duration of subsequent investigations should be guided by the likelihood of the arrhythmia being significant
  • other possible investigations include:
    • thyroid function tests, full blood count } together with a 12-lead ECG, these are often baseline tests when assessing a patient with palpitations in primary care
    • echocardiogram to detect structural heart disease
    • exercise testing when the problem is related to exercise
    • ambulatory ECG - the aim to is to obtain an ECG trace whilst the arrhythmia is occurring e.g. use of a 24-hour ECG tape. It is important to match the patients symptoms to particular rhythm disturbances on the ECG tape. This is because brief arrhythmias are a fairly common finding even in asymptomatic patients

Reference:

1. British Heart Foundation (Factfile 4/2004). Palpitations: their significance and investigation.