Palpitation Assessment Tool

Palpitation Assessment and Management Tool

Quick Assessment

Use this tool to systematically evaluate patients presenting with palpitations and determine appropriate interventions.

Differential Diagnosis

Cause Characteristics Associated Symptoms Risk Factors
Cardiac Arrhythmias Sudden onset, irregular rhythm, "flip-flopping" sensation Chest pain, syncope, dyspnea, diaphoresis CAD, HTN, cardiomyopathy, valvular disease
Anxiety/Stress Gradual onset, regular rhythm, awareness of heartbeat Hyperventilation, paresthesias, trembling Anxiety disorders, stressful events
Other Causes Variable presentation Depending on cause (see below) See below

Assessment Flowchart

Step 1: Assess ABCs (Airway, Breathing, Circulation)
Step 2: Check for red flags:
Step 3: If red flags present → Urgent Action Needed
Step 4: If no red flags, assess for:
Step 5: Perform physical exam:
Step 6: Obtain ECG if available

Red Flag Management

Immediate Actions for Critical Findings

  1. Call physician/Rapid Response Team immediately
  2. Obtain STAT 12-lead ECG
  3. Start continuous cardiac monitoring
  4. Establish IV access
  5. Prepare emergency equipment (crash cart, defibrillator)
  6. Monitor vital signs every 5-15 minutes

Potential Critical Conditions: VTach, SVT with hemodynamic instability, AFib with RVR, complete heart block

Non-Urgent Management

Anxiety/Stress-Related Palpitations

  1. Provide calm, quiet environment
  2. Encourage slow, deep breathing (5 sec inhale, 7 sec exhale)
  3. Offer reassurance and education
  4. Consider PRN anxiolytic if ordered
  5. Teach grounding techniques (5-4-3-2-1 method)
  6. Recommend follow-up with primary care or mental health

Common Causes and Interventions

Cause Assessment Clues Nursing Actions
Atrial Fibrillation Irregularly irregular pulse, pulse deficit 12-lead ECG, monitor for embolic signs, prepare for possible cardioversion
PVCs Isolated "skipped beats", normal rhythm between Reassurance, reduce caffeine/stress, monitor for increasing frequency
Hyperthyroidism Weight loss, heat intolerance, tremor, exophthalmos Check thyroid function tests, monitor for thyroid storm
Anemia Fatigue, pallor, exertional dyspnea Check CBC, assess for bleeding sources, supplemental O2 if needed
Medication Side Effects Recent medication changes, timing correlation Review medication list, hold suspect medications per protocol

Patient Education Points

Note: This tool is for clinical decision support only. Always use nursing judgment and consult with the healthcare team as needed. Document all assessments and interventions thoroughly.