-notes from lecture given 21/3/17 by Dr Goodfellow at grand round, UHW –



From the history you can determine a lot:

If the palpitations are noticed  in quiet times they gradually start and stop and/or they are a normal or faster than normal. (and the biochem/TFTs/CXR/Bloods are normal) and there has been berivement or stressors. These are normally low risk.

If they are irregular the patient may describe “stopped”, “Stopped/start”, “Thump / erratic”, “all over the place” – its usually an arrhthmia – usually AF.

If there is abrupt onset or abrupt termination these are often a ter-entrant tachcardia – AV or atrial flutter or scar related VT.

Vagal manoveures may teminate these, adenosine will work if it’s an AV node re-entry.

Contributing factors are:

Anxiety / Depression

Caffine / alcohol  ilicit drugs – cocatine / speed / ecxstacy

Meds – beta-agnosists

QT prolongation


The red flags are:



chest pain


previous MI or IHD

Family history of unexplained death < 35yrs (if the ecg and echo are abonormal then low risk)


Only do a 24hour ecg if the symptoms are daily

“Dear Doctor letter” – so when they have symptoms the ecg can be done immediately in the department

Loop recorder (reveal) or electorphysilogical study

AliveECG smartphone app – allows people to hold the phone when they’re having the palpitations and this gives an ecg.