Palpitations & Tachycardias - Emergency Medicine Revision
Palpitations are a common ED complaint, ranging from benign sinus tachycardia or anxiety‑related symptoms to life‑threatening arrhythmias (SVT, VT). In the ED the priorities are rapid assessment of haemodynamic stability, early rhythm diagnosis (12‑lead ECG while symptomatic), continuous monitoring, and following an evidence‑based acute management pathway (Resuscitation Council UK adult tachyarrhythmia algorithm).
Learning objectives
- Identify haemodynamic instability that requires immediate synchronized cardioversion.
- Classify tachycardia by QRS width and regularity and apply the Resuscitation Council tachyarrhythmia pathway.
- Perform safe acute interventions (vagal manoeuvres, adenosine technique, cardioversion) and recognise when to seek specialist help.
- Manage common ED presentations: SVT, AF, monomorphic VT, polymorphic VT/torsades, and pre‑excited rhythms.
Key guideline sources
- Resuscitation Council (UK) adult tachyarrhythmia algorithm and ALS guidance.
- NICE NG196 for atrial fibrillation.
- NICE CG95 for suspected acute coronary syndromes.
Initial approach and priorities
- Immediate ABCDE assessment.
- If the patient is unstable, prepare for immediate synchronized cardioversion - do not delay for detailed rhythm interpretation (Resuscitation Council).
- Attach continuous cardiac monitoring and record a 12‑lead ECG early (capture rhythm while symptomatic if possible).