Palpitations

In the practice

• 12-lead ECG (during an episode if possible, otherwise between episodes); pulse, blood pressure, cardiac auscultation

Laboratory tests (non-fasting)

• FBC (if anaemia or another systemic cause suspected)if needednon-French guidelineAn American general medicine review puts FBC in the baseline tests ^[1], as does a British review ^[3] and local UK protocols ^[4,5]. EHRA reserves it for cases where a systemic or drug cause is suspected ^[2], and ESC considers laboratory tests useful in particular cases ^[6].
• TSH (if thyroid dysfunction suspected)if needednon-French guidelineAn American general medicine review puts thyroid tests in the baseline tests ^[1], as does a British review ^[3] and local UK protocols ^[4,5]. EHRA reserves them for cases where a systemic or drug cause is suspected ^[2], ESC considers them useful in particular cases ^[6], and NICE proposes these tests when clinically suspected, reminding that an isolated symptom may not indicate thyroid disease ^[7].
• Serum electrolytesif needednon-French guidelineDiuretic or laxative, vomiting or diarrhoea, renal failure, documented rhythm disorders: serum electrolytes and kidney function are part of the baseline tests in the 2017 American review ^[1], and of the assessment “in particular cases” for ESC ^[6].
• Serum creatinineif needednon-French guidelineDiuretic or laxative, vomiting or diarrhoea, renal failure, documented rhythm disorders: serum electrolytes and kidney function are part of the baseline tests in the 2017 American review ^[1], and of the assessment “in particular cases” for ESC ^[6].
• Plasma glucose (if treated diabetes or episodes suggesting hypoglycaemia)if needednon-French guidelineSuspected systemic cause, notably hypoglycaemia in a person with treated diabetes: EHRA lists plasma glucose among the targeted tests ^[2].
• β-hCG (if pregnancy possible)if needednon-French guidelineLate period or possible pregnancy: pregnancy is among the non-cardiac causes of palpitations ^[1,2].
• Urinary metanephrines (if hypertensive surges, headaches, sweating)if needednon-French guidelineSuspected phaeochromocytoma, a rare cause of palpitations ^[1]: EHRA lists urinary catecholamines among the targeted tests ^[2].
• Urine drug screen (if use suspected and denied)if neededCocaine, amphetamines, ecstasy and cannabis can cause arrhythmias ^[1]; EHRA lists the search for illicit substances in blood or urine ^[2]. NABM coverage limited to emergencies and therapeutic monitoring ^[8].