Conditions
Palpitations risk stratification
Primary care triage framework for palpitations with immediate screening for unstable or high-risk rhythm concerns.
Last reviewed 2026-02-07|palpitations | cardiac | risk stratification
Assessment priorities
- Clarify onset, duration, associated symptoms, and exertional or rest pattern.
- Screen for syncope, chest pain, dyspnea, stimulant use, and thyroid context.
- Obtain focused exam and rhythm-focused baseline investigation where available.
Red flags
- Palpitations with syncope, chest pain, hemodynamic instability, or severe dyspnea.
- Sustained rapid rhythm with poor perfusion signs.
- New high-risk arrhythmia concern in structurally vulnerable patients.
Initial management
- Use risk framing to separate urgent escalation from planned outpatient rhythm workup.
- Address reversible contributors (dehydration, stimulants, medication effects).
- Document explicit escalation thresholds and follow-up timing.
Follow-up and escalation
- Arrange short-interval reassessment when diagnosis remains uncertain.
- Escalate rapidly for recurrent syncope, worsening dyspnea, or persistent instability.
- Coordinate cardiology referral for recurrent/high-risk patterns.