๐Ÿ“ Palpitations History OSCE Checklist
High-Yield Notes Full Script

High-Yield OSCE Points ๐Ÿง 

๐Ÿ’ฌ Introduction & ICE

๐Ÿ’“ History of Presenting Complaint (Palpitations-Specific)

๐Ÿ“œ Past Medical & Surgical History

๐Ÿ’Š Drug History & Allergies

๐Ÿ‘จโ€๐Ÿ‘ฉโ€๐Ÿ‘งโ€๐Ÿ‘ฆ Family & Social History

โœ”๏ธ Closing the Consultation

Full Word-for-Word OSCE Script ๐Ÿ“œ

๐Ÿ’ฌ Opening and Understanding

"Hello, Iโ€™m [Your Name], one of the doctors/nurses. I understand you've come in today because you've been experiencing palpitations. Is that right?"

"Before we go any further, what are your thoughts about what might be causing these palpitations, or what they might mean?"

"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"

๐Ÿ’“ Exploring the Palpitations (Palpitations-Specific)

"Could you please describe the feeling you're experiencing in your chest? Do your heartbeats suddenly feel more noticeable? Is it a pounding, fluttering, or racing sensation? Or does it feel like your heart is skipping beats or beating irregularly?"

"When did you first start noticing these palpitations? Did they come on very suddenly, or gradually? What were you doing when they started โ€“ were you at rest, exercising, lying down, waking up from sleep, or after a sudden movement?"

"Have you identified any obvious triggers for your palpitations? For example, does it happen after exertion, when you change position, when you're feeling anxious or stressed? What about after consuming caffeine, alcohol, or nicotine? Does sleep deprivation play a role? Have you noticed them when you're ill or have a fever?"

"Have you found anything that improves or stops the palpitations? For example, certain breathing techniques, splashing cold water on your face, resting, or taking any medication?"

"Do the palpitations feel fast or slow? Have you ever tried to feel your pulse during an episode and recorded the rate, or noticed if it felt regular or irregular?"

"How long do individual episodes of palpitations usually last โ€“ just a few seconds, minutes, or do they go on for hours? And how often do they occur โ€“ daily, weekly, or monthly?"

"Have you experienced any other concerning symptoms with the palpitations? Like feeling faint or actually fainting (syncope)? Or feeling lightheaded or like you're about to pass out (pre-syncope)? Have you had any chest pain (angina), or shortness of breath? Do they occur specifically during exercise or exertion? What about excessive sweating, extreme fatigue, dizziness, or even collapsing?"

"I also need to ask about some specific symptoms that might point to an underlying cause. Have you had any chest pain that feels like a heart attack? Any heat intolerance, unexplained weight loss, or tremor, which might suggest a thyroid issue? Have you experienced panic attacks, or changes in your vision or any new weakness or numbness?"

๐Ÿ“œ Past Medical & Surgical History

"Do you have any existing medical conditions? It's important to know if you have any pre-existing heart or cardiovascular diseases, such as a previous heart attack, heart failure, high blood pressure, problems with your heart valves, congenital heart conditions, or known arrhythmias. Do you have any cardiovascular risk factors like diabetes, high cholesterol, or obesity? What about thyroid disease, anaemia, or any known electrolyte imbalances? Do you have any current mental health issues like anxiety or depression, or a history of panic disorder?"

"Have you ever had any operations or procedures, especially any heart procedures like an ablation (to correct heart rhythm), pacemaker insertion, or heart valve surgery?"

๐Ÿ’Š Drug History & Allergies

"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Some medications, like those for heart rhythm (antiarrhythmics), blood pressure (beta-blockers, diuretics), thyroid hormones, or even common inhalers (bronchodilators like salbutamol) or nasal decongestants, can sometimes cause palpitations. Do you consume a lot of caffeine-containing products?"

"Have there been any recent changes to your medications โ€“ perhaps a new one started, one stopped, or a dose changed?"

"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"

๐Ÿ‘จโ€๐Ÿ‘ฉโ€๐Ÿ‘งโ€๐Ÿ‘ฆ Family & Social History

"Does anyone in your close family โ€“ like your parents, siblings, or children โ€“ have a history of cardiovascular disease, or particularly any cases of sudden cardiac death, especially at a young age? What about inherited heart conditions like Long QT syndrome, Brugada syndrome, or hypertrophic cardiomyopathy, or other heart rhythm problems?"

"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? Are you able to manage all your daily activities independently?"

"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs, especially stimulants like cocaine, amphetamines, or ecstasy, as these can significantly impact your heart?"

"What's your typical diet like, and how about your weight? Do you exercise regularly, and if so, do you notice palpitations occurring during exercise?"

"What kind of work do you do? If your job involves working at heights or with heavy machinery, it's very important that you do not return to work until we have fully investigated the cause of your palpitations and deemed it safe."

"Regarding driving, it is crucial that you do not drive until you have been fully investigated for your palpitations and cleared by a medical professional. You will also need to check with the DVLA or your local licensing authority regarding their specific requirements for notifying them."

โœ”๏ธ Closing the Consultation

"Thank you very much for sharing all of that information with me. Just to summarise, you've been experiencing [recap key symptoms], which started [onset] and are often [character/timing]. This has been impacting your [daily life areas]. You've also mentioned [recap relevant PMH/DH/FH/SH]."

"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"

"Based on what you've told me, the next steps would be for me to perform a physical examination, focusing on your cardiovascular system, and checking your vital signs. We would also likely arrange for some investigations, such as an ECG (heart tracing), blood tests (like a full blood count, kidney and liver function tests, thyroid function tests, glucose, and cardiac enzymes if needed). Depending on the nature of your palpitations, we might also consider a Holter monitor (a portable ECG recorder for 24-48 hours) or an event recorder (worn for longer periods), an echocardiogram (ultrasound of the heart), or an exercise tolerance test. We may also refer you to a heart specialist (cardiologist) for further assessment."

"Do you have any questions for me at this stage?"

"Thank you for your time."