Palpitations – when to refer

This week’s CPD unit in the BMJ was on palpitations. Looking through it, I saw that the things I would do for history, examination, and basic investigations matched with what the article advised, so it looks as though I’m managing patients appropriately there. What was useful, however, was a section on when referral to cardiology is appropriate; always helpful when struggling to find the ever-elusive balance between over-referring and under-referring!

Urgent referral

  • Palpitations associated with syncope or pre-syncope
  • Palpitations triggered by exercise
  • Family history of sudden cardiac death, or other inheritable cardiac conditions (I assume they mean those associated with sudden death, not just IHD?)
  • Second-degree or third-degree block on ECG

Routine referral

  • Palpitations associated with symptoms such as chest pain or light-headedness
  • Recurrent sustained AF, tachyarrhythmia, or flutter (but surely they don’t mean to refer everyone who has paroxysmal or persistent AF?)
  • History or examination indicating structural heart disease, hypertension, or heart failure (again, surely we shouldn’t be referring everyone with hypertension and palpitations? Or CCF?)
  • History clearly suggesting paroxysmal SVT but no luck capturing this on multiple ambulatory rhythm recordings
  • Abnormal 12-lead ECG, other than second or third-degree heart block as covered above.

(BMJ 2015;351:h5649)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Cardiovascular, Credits 2016. Bookmark the permalink.

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