The Initial Evaluation of the Patient with Palpitations or Syncope

Patients with cardiac arrhythmias may come to the attention of their physicians in a variety of ways. An asymptomatic arrhythmia may be fortuitously discovered on a routine electrocardiogram (ECG) or physical exam. Alternatively, a patient may present with a complaint suggestive of arrhythmia, usually palpitations, syncope, or presyncope. Finally, patients who have no history of arrhythmia, but who may be prone to ventricular tachyarrhythmias because of underlying heart disease, may undergo routine testing to evaluate their level of risk. Patients in each category may be evaluated by invasive or noninvasive means. This chapter focuses on the noninvasive evaluation of patients with suspected arrhythmias and discusses indications for invasive testing.