Palpitations

Template

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Red flags presentChoose any

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Palpitations
• Palpitation history reviewed, including onset, duration, rhythm, triggers, associated symptoms, and relation to exercise
• Caffeine, energy drink, nicotine, medication, and substance exposures reviewed
• No palpitations with exercise, fainting or near fainting, chest pain or shortness of breath, family history of early sudden cardiac death, or known heart disease
• Normal resting heart rate, regular rhythm, normal right-arm blood pressure and oxygen saturation, and normal cardiac exam
• ECG normal, without pre-excitation or a prolonged QT
• Palpitations most consistent with a benign cause, without red flags
• Advised a symptom and heart rate log when episodes occur
• Discussed hydration, regular meals, sleep, and avoiding caffeine, energy drinks, and other stimulant triggers
• Cardiology referral if episodes recur or new symptoms develop
• Follow up if episodes recur

Most palpitations in children and teens come from normal changes in heart rate or harmless extra beats. Recommended supportive care with an emphasis on drinking water throughout the day, regular sleep, and avoiding caffeine and energy drinks. Return precautions given including fainting, especially with exercise, chest pain, a racing heartbeat that does not settle, trouble breathing, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

History reviewed; exposures reviewed
Pattern: premature beats, sinus tachycardia, possible SVT
Contributors (caffeine, stimulants, decongestants, anxiety, illness, fluids, sleep, nicotine or marijuana)
Red flags present or absent
Cardiac exam
ECG obtained and reviewed
Labs based on symptoms
Vagal maneuvers; smartwatch strip; stop energy drinks
Hold sports until cardiology

Used to decide, kept out of the note

Eyeball pressure, carotid massage

Return precautions in the template

faintingespecially with exercisechest paina racing heartbeat that does not settletrouble breathing

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.