Palpitations can result from cardiac awareness (increased conscious perception of the heart beating) or from a fast or irregular cardiac rhythm. Most causes for palpitations in the teenager can be diagnosed with minimal testing. Patients with an abnormal ECG, non-sinus tachycardia, abnormal cardiac examination, concerning family history, or palpitations associated with activity or syncope should be referred to a pediatric cardiologist. This article discusses the evaluation, testing, and management of teenagers with palpitations. It also provides a general guideline for referral for subspecialty evaluation.
Key points
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The history and physical examination, along with an ECG, should provide a general diagnostic category of the palpitations.
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Every portion of the history is important: the history of present illness; review of systems; and medical, family, social, as well as medication history; including information of drugs of abuse. Issues specific to teenagers should be addressed.
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Further testing (if needed), should be able to provide a specific diagnosis.
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Patients with a cardiac cause of palpitations and/or nonsinus tachycardia should be referred to a pediatric cardiologist for further evaluation.
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