Recognising Palpitations for Student Nurses
Learn how to respond when a patient reports palpitations, assess the wider cardiovascular picture and recognise associated symptoms that may require prompt clinical escalation.
What might a patient mean by “palpitations”?
Patients describe palpitations in different ways. Listening carefully to their description can provide useful information for the clinical team.
“My heart is racing”
The patient may describe a rapid or suddenly accelerated heartbeat.
“It's fluttering”
Some patients describe an irregular, fluttering or uneven sensation.
“It's pounding”
The heartbeat may feel unusually strong or prominent to the patient.
“It keeps missing”
Patients may describe pauses, extra beats or the sensation of a skipped heartbeat.
“It just started”
Establish when the symptoms began and whether the onset was sudden or gradual.
“It comes and goes”
Ask whether the sensation is continuous or occurs in episodes.
What should you find out?
When did it start?
Establish the onset and whether symptoms began suddenly or gradually.
What does it feel like?
Ask the patient to describe the sensation in their own words.
How long has it lasted?
Establish whether the symptoms are ongoing, intermittent or have already stopped.
Are other symptoms present?
Ask about chest discomfort, breathlessness, dizziness, weakness, syncope or near-syncope.
Obtain observations
Assess pulse and appropriate physiological observations within the wider clinical picture.
Escalate concern
Communicate significant symptoms or physiological deterioration according to local procedures.
Connect the symptom with what you observe
When appropriate, assess the patient's pulse while they are experiencing symptoms and connect your finding with the wider cardiovascular assessment.
Has the pulse changed?
Compare the current pulse rate with previous observations and the patient's baseline.
Does it appear regular?
A newly irregular pulse should be communicated and assessed appropriately.
How is the patient tolerating it?
Associated chest pain, breathlessness, dizziness or collapse significantly increases concern.
Assess symptomatic palpitations within the whole patient
Airway
Identify and respond to immediate airway concerns first.
Breathing
Assess respiratory rate, oxygen saturation, work of breathing and new breathlessness.
Circulation
Assess pulse, blood pressure, peripheral perfusion, symptoms and other relevant cardiovascular findings.
Disability
Assess consciousness and identify dizziness, collapse or new neurological change.
Exposure
Consider temperature and other clinical findings relevant to the patient's presentation while maintaining dignity.
Escalate
Follow local emergency procedures when palpitations occur with significant physiological deterioration or concerning symptoms.
Palpitations become more concerning when other symptoms appear
Pain or discomfort
New significant chest discomfort alongside palpitations requires prompt clinical assessment.
Breathlessness
New or severe breathlessness should be assessed within the wider ABCDE picture.
Dizziness or faintness
Feeling faint or dizzy may suggest the patient is not tolerating the cardiovascular change well.
Syncope
Palpitations associated with loss of consciousness require prompt assessment and escalation.
Pale or clammy skin
Skin and perfusion changes may indicate wider cardiovascular deterioration.
Changing circulation
A significant blood pressure change alongside palpitations can increase concern.
When palpitations need prompt escalation
- Palpitations with significant chest pain or chest discomfort.
- Palpitations accompanied by severe or worsening breathlessness.
- Palpitations associated with syncope or near-syncope.
- New altered consciousness or significant confusion.
- Palpitations with significant blood pressure deterioration.
- Marked pulse abnormality with signs of poor perfusion.
- Rapidly worsening physiological observations.
- Persistent symptoms in a patient who appears acutely unwell.
A patient suddenly feels their heart racing
Example
A patient presses the call bell and tells you their heart has suddenly started “racing”.
They appear pale and say they feel light-headed. Their pulse is considerably faster than earlier and their blood pressure has fallen from the previous observation.
Rather than trying to determine the rhythm yourself, you recognise the important pattern: palpitations + pulse change + dizziness + blood pressure deterioration.
You begin an ABCDE assessment and escalate promptly according to local procedures.
Describe exactly what is happening
Example escalation
“I'm concerned about Mr Ahmed. He has developed sudden palpitations and describes his heart as racing. He is now light-headed and pale. His pulse is significantly faster than earlier and his blood pressure has fallen from his previous reading.”
This communicates the symptom, onset, associated features and objective deterioration without attempting to diagnose the rhythm.
Record useful clinical information
- Record when the palpitations began where known.
- Document the patient's description of the sensation.
- Record whether symptoms are continuous or intermittent.
- Document pulse and relevant physiological observations.
- Record associated symptoms such as dizziness or chest discomfort.
- Document changes from previous observations or baseline.
- Record escalation and subsequent action according to local policy.
Errors to avoid when a patient reports palpitations
- Assuming palpitations automatically mean one particular arrhythmia.
- Ignoring the patient's own description of the symptom.
- Checking pulse rate without considering rhythm or associated symptoms.
- Ignoring blood pressure and peripheral perfusion.
- Failing to establish whether the symptom is new.
- Ignoring dizziness, chest discomfort or breathlessness.
- Trying to diagnose the rhythm before escalating deterioration.
- Assuming symptoms are harmless because they have stopped.
Listen → assess → connect → escalate
Understand the symptom
Establish what the patient feels, when it began and whether other symptoms are present.
Build the cardiovascular picture
Connect pulse, blood pressure, perfusion, symptoms and wider ABCDE findings.
Escalate significant change
Describe what has changed and why you are concerned without trying to diagnose the underlying rhythm.
Palpitations are a symptom — assess the patient behind them
Clinical confidence comes from listening carefully, identifying associated warning signs and connecting the symptom with pulse, circulation and the wider ABCDE assessment.
Explore Clinical Confidence →