The initial assessment seeks to identify the likely mechanism of palpitation and determine whether significant underlying heart disease is present.
History and symptom description
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Obtain a detailed description of the sensation; patients can demonstrate the perceived rhythm by tapping with their hand.
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A provisional diagnosis can usually be made from the history.
Extrasystoles
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Recurrent, short-lived bouts of irregular rhythm are usually due to atrial or ventricular extrasystoles, also called ectopic beats.
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Patients may describe a flip or jump in the chest, or dropped or missed beats.
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Extrasystoles are often more frequent during stress or debility and may be triggered by alcohol or nicotine.
Patterns suggesting other mechanisms
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A pounding, forceful and relatively fast heartbeat at 90–120/min commonly accompanies anxiety.
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This pattern may also reflect a hyperdynamic circulation in anaemia, pregnancy or thyrotoxicosis, or occur with valve disease such as aortic regurgitation.
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Discrete episodes of regular heartbeats above 120/min are more likely to represent paroxysmal supraventricular or ventricular tachycardia.
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Atrial fibrillation typically causes irregular and usually rapid palpitation.