Palpitations – Differential Diagnosis

Common causes

Must Not Miss

Easily missed

Red flags

Palpitations on exertion
Chest pain
Syncope or near syncope
Dyspnoea, Orthopnoea , Oedema
Hypotension
Abnormal ECG

Investigations to consider

FBC, D-dimers
U+Es, LFTs, TFTs, Serum glucose/lipids
Troponin/Cardiac enzymes
ECG
24h ECG
CXR
Echocardiography
V/Q scan

NOTES: Please read
- **These lists could never be comprehensive and remain practical to use during the consultation. We have included conditions that we think will cover the vast majority of primary care presentations for any given symptom. This does not mean other conditions; red flags and investigations should not be considered.
- **Each list is provided as a brief reminder only and is presented in no particular order. The authors have used editorial licence to allow quicker access during the consultation and to prevent duplication.
- **We feel that the 'Must not Miss' conditions should always appear at the top of your differential diagnosis list. The consequences of missing a diagnosis from within this category carry significant morbidity and mortality risks to your patient.
- **Many diagnoses are not obvious or apparent at the initial presentation. It may be appropriate to share your diagnostic uncertainty with patient, and also provide specific guidance on when and where patients should seek further advice and follow up.