The evaluation of palpitations begins with a medical history and physical examination.

Physical findings in someone with palpitations may include:

• Rapid pulse
• Irregular pulse
• Excessive sweating
• Heart murmur
• High blood pressure
• Low blood pressure
• Irregular heartbeat
• Swelling of the legs and feet
• Swelling of the veins in the neck
• Xanthelasma

Tests are necessary to evaluate palpitations in the elderly and in those with heart disease. Tests may not be necessary to evaluate palpitations in children and young adults.

Tests that may be used to evaluate palpitations include:

• Electrolyte profile
• Kidney profile
• Complete blood count
• Thyroid profile
• Pulse oximetry
• Chest x-ray:
• Normal chest x-ray
• Heart failure
• EKG
• Cardiac monitoring
• 24-hour cardiac monitor: a portable ECG that measures the heart's rate and rhythm over a 24-hour period (or longer)
• Intracardiac electrophysiologic studies:
• During EPS the heart is stimulated with tiny electrical currents in order to find the cause of an arrhythmia.
• Exercise stress test
• Cardiac catheterization
• Echocardiogram
• MRI scan of the heart:
• Shows detailed images of the heart and coronary arteries
• Detects structural abnormalities of the heart
• SPECT scanning of the heart:
• Detects blood flow abnormalities to heart muscle
• Thallium heart scan
• Coronary artery CT scanning:
• Checks for possible obstructions in the coronary arteries
• Can show a build-up of calcium in a coronary artery
• MUGA scan