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