Palpitation

Palpitation are common and often experienced as a fluttering sensation in the chest, either occurring alone or associated with chest pain, shortness of breath, dizzy spells or blackouts/syncope. Palpitation are commonly due ectopic beats but may represent an underlying arrhythmia, particularly if symptoms are recurrent or sustained nature and should be investigated promptly.

Investigation of palpitation

Patients with palpitation often require further investigation to assess for both slow (bradyarrhythmia) or fast (tachyarrhythmia) abnormal heart rhythm and for structural heart disease, including the following:

  • Blood tests including thyroid function tests
  • 12-lead Electrocardiogram (ECG)
  • Echocardiogram
  • 24 hour to 7 day ECG Holter (heart monitor)
  • Event recorders
  • Implantable loop recorders

Treatment of arrhythmia

If a diagnosis of arrhythmia is confirmed, medical treatment with drugs such as beta-blockers, calcium channel antagonists or antiarrhythmics may be required. Formal blood thinners, such as Warfarin or Direct Oral Anticoagulants (DOAC), may need to be considered for certain arrhythmias including atrial fibrillation or atrial flutter. Carefully selected patients may benefit from invasive procedures such as catheter ablation.