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!
- 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
- 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.