📊 Overview
• Palpitations = sensation of heart's action (racing, skipping, stopping, fluttering)
• Most cases NOT serious cardiac disease
• Goal: identify small proportion at risk for serious arrhythmias
• Infants: nonspecific (irritability, poor feeding, heart failure)
⚠️ Red Flags (Urgent Cardiac Evaluation)
• Palpitations + syncope (especially with exertion)
• Palpitations + severe chest pain
• Family history: long QT, sudden death, HCM, WPW
• History of heart disease or cardiac surgery
• Palpitations during exercise
🩺 Benign Causes
• Sinus tachycardia: fever, pain, anxiety, anemia, caffeine, stimulants (ADHD meds)
• Premature atrial contractions (PACs): benign, occasional "skipped beat"
• Premature ventricular complexes (PVCs): common (25% population), usually benign; worrisome if: syncope, heart disease, runs, multifocal, exertion-induced
⚠️ Arrhythmias Requiring Evaluation
• SVT (re-entrant): abrupt onset/termination, narrow complex, rate >180-240 bpm, may cause heart failure in infants
• WPW: delta wave, accessory pathway, risk of SVT and sudden death (rare)
• Atrial flutter: sawtooth waves, 250-300 bpm, often with structural heart disease
• Long QT: torsade risk, acquired (drugs) or congenital
📌 Decision strategy: ECG for all patients with palpitations. Holter for frequent symptoms; event recorder for intermittent symptoms. Palpitations + syncope/exertion/structural heart disease = cardiology referral.