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Palpitations (cont.)

Exams and Tests

As is often the case in medicine, the key to diagnosis is from the 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 healthcare provider, physical examination is not that helpful. The healthcare provider will likely check vital signs like 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 like clicks or murmurs.

If the palpitations are present at the time of the visit to the healthcare provider, an electrocardiogram(ECG) and a heart monitor that records heart rate and rhythm will likely establish the diagnosis. If the palpitations have already resolved, the ECG and monitor may not necessarily be helpful. They may show normal results after the symptoms are gone.

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.