How Are Palpitations Diagnosed?

Your doctor will first want to find out whether your palpitations are harmless or related to a more serious heart problem. To do this, he or she will ask about your symptoms and medical history, do a physical exam, and order several basic tests.

This information may point to a heart problem as the cause for your palpitations. If so, your doctor may recommend more tests. These will help show what the problem is and how to treat it.

The cause of palpitations may be hard to diagnose, especially if symptoms don’t occur regularly.

Specialists Involved

Several types of doctors may work with you to diagnose and treat your palpitations. These include a:

• Primary care doctor
• Cardiologist (a doctor who specializes in treating adults who have heart problems)
• Electrophysiologist (e-LEK-tro-fiz-e-OL-o-jist; a cardiologist who specializes in the heart’s electrical system)

Medical History

Your doctor will ask questions about your palpitations, such as:

• When did they begin?
• How long do they last?
• How often do they occur?
• Do they start and stop suddenly?
• Does your heartbeat feel steady or irregular during the palpitations?
• What other symptoms do you have when you get palpitations? (See “What Are the Signs and Symptoms of Palpitations?”)
• Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?

Your doctor also will ask you about your use of caffeine, alcohol, supplements, and illegal drugs.

Physical Exam

Your doctor will take your pulse to find out how fast your heart is beating and whether it’s beating with a normal rhythm. He or she also will use a stethoscope to listen to your heartbeat.

Your doctor also may look for signs of other conditions (such as an overactive thyroid) that can cause palpitations.

Diagnostic Tests

Often, the first test that’s done is an EKG (electrocardiogram). This simple test records your heart’s electrical activity. An EKG is used to detect and locate the source of heart problems. It shows how fast your heart is beating and whether its rhythm is steady or irregular. It records the strength and timing of electrical signals as they pass through each part of your heart.

Even if your EKG results are normal, you may still have a medical condition that’s causing palpitations. If your doctor suspects this is the case, he or she will order blood tests to gather more information about your heart’s structure, function, and electrical system.

Holter Monitor

A Holter monitor records the electrical signals of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

Holter or Event Monitor

Figure A shows how a Holter or event monitor attaches to a patient. In this example, the monitor is clipped to the patient’s belt and electrodes are attached to his chest. Figure B shows an electrocardiogram strip, which maps the data from the Holter or event monitor.

During the 24- or 48-hour period, you do your usual daily activities. You keep a notebook and note any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.

Event Monitor

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart’s electrical activity at certain times while you’re wearing it.

For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.

Event monitors can be worn for 1 to 2 months, or as long as it takes to record your heart’s activity during palpitations.

Echocardiography

Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart. It also shows your heart valves and how well they're working.

Stress Test

Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.