Heart Disease (Coronary Artery Disease) Slideshow Pictures Medical Illustrations of the Heart Image Collection Take the Heart Disease Quiz!

Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

View Full Profile

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

Palpitations Diagnosis

The key to diagnosis is the patient's medical history.

• When do the palpitations occur?
  
  
• Do they come and go, or are they relatively isolated?
  
  
• How long do they last?
  
  
• What other symptoms are associated with them?
  
  
• Are there ingestions, like caffeine, alcohol, medications, or drugs associated with the symptoms?
  
  
• Are there any underlying medical problems that could be a potential cause?

Unless the palpitations are occurring during the visit to the health care practitioner, physical examination may not be that helpful. The health care practitioner will likely check the patient's vital signs such as pulse and blood pressure, and look for signs of underlying physical problems, such as a goiter (enlarged thyroid gland in the neck) and listen to the heart to check for abnormal sounds such as clicks or murmurs associated with heart valve abnormalities.

If the palpitations are present at the time of the visit to the health care practitioner, an electrocardiogram (ECG) and a heart monitor that records heart rate and rhythm may help establish the diagnosis. If the palpitations have already resolved, the ECG and monitor may not necessarily be helpful. They may show normal results if the symptoms are not present.

Blood tests may be ordered to check hemoglobin and red blood cell counts for anemia, to determine whether there are any electrolyte abnormalities, to check kidney function (since abnormal kidney function may affect electrolyte levels), and to check thyroid function. The levels of certain medications may also be tested in the blood.

For many people, there is a struggle to find out what heart rhythm is causing the palpitations. Inevitably, the symptoms do not always appear during the doctor's visit. Admission to the hospital is not usually effective, since lying in a hospital bed does not replicate the patient's function in their active world where the symptoms occur. A variety of outpatient heart rate monitoring devices can be worn by the patient to try to capture and record abnormal beats. These rhythm strips are computer analyzed and may give clues as to the underlying cause of palpitations. Some types of monitors are worn for one or two days, while event monitors can be worn for a month. Occasionally a patient may have a device implanted under the skin for even longer monitoring.