Palpitations
General information
Palpitations are a common presentation in paediatrics and are often due to awareness of a fast heart rate (sinus tachycardia) but can be due to SVT or rarely VT.
Initial management
- Consider 12 lead ECG (use adult positions)
- Assess for abnormalities on cardiac examination
- Establish if there is a family history of sudden cardiac death, cardiomyopathies or channelopathies (Brugada syndrome, Long QT, short QT).
- Teach the parents to quantify the pulse during symptoms (use of stethoscope or technology such as smart watches can help)
Who to refer
- Sudden onset or offset of palpitations
- Cardiac family history
- Abnormal ECG or cardiac examination
- Unclear cause and persistent symptoms
Urgent referral if
- Palpitations are associated with collapse or pre-syncope
Same day if
- Unwell/haemodynamic compromise
How to refer
- Same day referrals/advice discuss with on-call paediatric registrar Ninewells
- Outpatient referrals/routine advice - SCI Gateway/Paediatrics