My general approach to palpitations involves a detailed history and examination, followed by investigations tailored to each patient’s clinical presentation. As there are many causes of palpitations, a detailed assessment is needed to distinguish the various causes. When looking out for irregular heart rhythms (arrhythmia) in particular, I pay attention to the heart rate (too slow or too fast?) , blood pressure (too low or too high?) , pulse (regular or irregular?) I will also auscultate the heart to check for abnormal heart sounds like murmurs.