Last reviewed 01/2018

  • 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


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