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FOCUSED SHIFT VIEW

Palpitations & Dysrhythmia

Capture the rhythm, then decide whether the patient or the ECG is unstable.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. ABCs, monitor, IV access and 12-lead ECG; treat instability immediately.
  2. Classify regular versus irregular and narrow versus wide only after checking the patient.
  3. Search for ischemia, electrolyte disturbance, thyroid disease, stimulant use, structural disease, and inherited-risk clues.

2 · Escalate now if

  • Syncope or persistent hypotension
  • Wide-complex or very rapid rhythm
  • Chest pain, ischemic ECG changes, or acute heart failure
  • Known structural heart disease or inherited-arrhythmia history
  • Palpitations during exertion or with stimulant/toxin exposure

3 · Immediate workup

  • 12-lead ECG and continuous rhythm monitoring
  • Glucose and targeted electrolytes; pregnancy test when relevant

4 · Don’t miss

  • Unstable tachyarrhythmia or bradyarrhythmia
    Hypotension, shock, ischemic pain, pulmonary edema, or altered mentation means immediate resuscitation per local ACLS protocol.
  • Ventricular tachycardia
    Assume wide-complex tachycardia is VT until expert review proves otherwise.
  • Pre-excited atrial fibrillation
    Irregular wide-complex rhythm may deteriorate rapidly; avoid AV-nodal blockers and IV amiodarone; unstable patients need cardioversion, stable patients need expert procainamide/ibutilide or cardioversion assessment.

5 · Disposition lane

Observation / telemetry

Uncaptured recurrent symptoms, abnormal ECG, electrolyte correction, new AF, or uncertain cause.

Resuscitation / ICU / cardiology

Unstable rhythm, VT, pre-excitation concern, high-grade block, ischemia, or decompensated heart failure.