[Diagnostic management of patients with palpitations]

In the diagnostic work-up of patients with palpitations the first-line investigations involve history, physical examination and 12-lead ECG. In a good proportion of patients, these investigations allow the prognostic stratification of patients and a definite or suspected diagnosis of the cause of symptoms. However, when results of the initial evaluation are negative (which occurs more frequently in paroxysmal, short-lasting palpitations) and the patient is suffering from heart disease, or if palpitations are frequent or poorly tolerated with a high probability of an arrhythmic origin, ambulatory electrocardiographic monitoring and/or electrophysiological study should be undertaken.