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This summarized table serves as a quick reference for clinicians on when to refer a patient with a history of palpitations, as well as what initial management steps should be considered in primary care.
| Scenario | Action/Management | Referral Timing |
|---|---|---|
| Urgent Cardiology Referral | Urgent | |
| ○ Syncope or near syncope | ||
| ○ Palpitations with exercise | ||
| ○ Family history of sudden cardiac death <40 | ||
| ○ Second or third degree atrioventricular block on ECG | ||
| Routine Cardiology Referral | Routine | |
| ○ Accompanying chest pain or lightheadedness | ||
| ○ History/symptoms of structural heart disease, heart failure, or hypertension | ||
| ○ Abnormal resting ECG, other than second/third-degree atrioventricular block | ||
| ○ History of recurrent sustained tachyarrhythmia, atrial fibrillation, or flutter | ||
| ○ Symptoms consistent with paroxysmal supraventricular tachycardia | ||
| ○ Ventricular extrasystoles or suspected VT if underlying heart disease is suspected | ||
| Generally No Referral | - Normal 12-lead ECG | None |
| ○ Not provoked by exercise | - Absence of lightheadedness, syncope, persistent breathlessness, or chest pain | |
| ○ No signs/history of structural heart disease, heart failure, hypertension | ||
| ○ No family history of sudden cardiac death | ||
| Primary Care Management | - Treat underlying cause | |
| ○ Sinus tachycardia | - Manage underlying cause, cardiovascular risk factors, and offer lifestyle advice | |
| ○ Atrial extrasystoles | - Manage cardiovascular risk factors and offer lifestyle advice... |
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