[The patient with palpitations: from the clinical picture to the therapeutic decision]

Palpitations are a common complaint in a medical consultation. The initial approach to the patient his based on the history, physical examination and 12-lead electrocardiogram (ECG). The history is very important because most patients are initially seen by physicians after the episode of palpitations. The analysis of the characteristics of the episode, the presence of cardiac pathology and the effects of previous treatments are very important. Physical examination during the episode can provide some physical signs that may suggest a certain etiology. The physical examination after an episode can diagnose a certain cardiac disease. The ECG during the episode is very important and can provide the diagnosis. A normal ECG outside an episode does not exclude an arrhythmia. The initial diagnostic evaluation is complemented with other examinations, such as echocardiography or coronariography, to analyse a cardiac disease. Some other investigations are necessary, such as ECG Holter, Transtelephonic monitoring of cardiac rhythm or electrophysiological investigation to complement an initial diagnosis. This therapeutic decision is based on the type of arrhythmias, the associated symptomatology, the cardiac structural disease and the activity of the patient.