Palpitations Triage
Tell benign palpitations from the dangerous kind — red-flag features and safe routing.
Learning Objectives
- 1.Screen palpitation calls for high-risk features.
- 2.Distinguish benign from concerning palpitations.
- 3.Route palpitation calls by urgency.
Purpose
Most palpitations are benign, but some signal a dangerous arrhythmia. The red flags are the company they keep — chest pain, fainting, or breathlessness.
What to ask
- •Happening now? Fast/slow? Regular or irregular?
- •Associated chest pain, lightheadedness, near-fainting, or fainting?
- •Shortness of breath?
- •How long, how often, what triggers it?
- •History: AFib, heart disease, fainting?
Red flags — escalate
- •Palpitations WITH chest pain, fainting/near-fainting, or severe shortness of breath.
- •Sustained very fast heart rate, or feeling about to pass out.
- •Known heart disease with new sustained palpitations.
Escalate
Palpitations with chest pain, syncope, or severe dyspnea → 911/ED and notify the provider. Isolated brief skips in a healthy patient are lower risk.
Sort the urgency
- •Emergent (911/ED): palpitations + chest pain/syncope/severe dyspnea.
- •Urgent (provider): sustained or recurrent, cardiac history.
- •Routine: brief, isolated "skips," no red flags — monitor per protocol.
What to send the provider
- •Now vs. resolved, rate/regularity, associated symptoms, duration/frequency, history, urgency read.
Patient education script
- •"If your heart races AND you feel chest pain or like you might pass out, call 911." / "Note when it happens and what you were doing."
Spanish phrase
Do you feel chest pain or like you might faint with the palpitations?
¿Siente dolor de pecho o como que se va a desmayar con las palpitaciones?
SYEN-teh doh-LOR deh PEH-cho oh KOH-moh keh seh vah ah des-mah-YAR kon las pal-pee-tah-SYOH-nes
Mini case
A patient calls with a racing, irregular heartbeat for the past hour, now feeling lightheaded and short of breath.
What now?
Show answer
Sustained palpitations with lightheadedness and dyspnea are concerning for a significant arrhythmia (e.g., AFib with rapid rate). Escalate urgently/emergently per severity — likely 911/ED — and notify the provider.
Checklist
- Asked if palpitations are active and the rate/regularity.
- Screened for chest pain, syncope, dyspnea.
- Routed by urgency; escalated red-flag combinations.