Palpitations

In the vast majority of cases, palpitations are a symptom of little clinical importance that does not warrant any particular diagnostic investigations other than a careful medical history, physical examination and standard 12-lead ECG. However, it should not be underestimated as it can be the only important symptom preceding a sudden death (sometimes in young subjects). It is not always possible to evaluate these cases swiftly. However, it requires all the physician’s skill to weigh up the medical history, clinical and electrocardiographic elements that constitute warning signs. We have observed that a history of palpitations or valve disease, fainting, especially due to exertion and poorly tolerated paroxysmal palpitations are all alarm elements. In the early weeks of life, we observed that certain subgroup of patients is at very high risk of sudden death and is unfortunately not diagnosed properly for slight and relatively unknown ECG alterations (Brugada syndrome, ARVD, long QT syndrome, idiopathic ventricular tachycardia) and the underestimation of warning signs (palpitations caused by exertion, unexplained episodes of fainting). The aim of this short work is to provide elements for guiding the identification of this very generic, misleading and complex symptom.