Arrhythmia & rhythm

Missed Palpitations cardiac cause negligence claims.

Expert witness reports where palpitations misdiagnosed as anxiety or benign extrasystoles concealed an underlying arrhythmia, ischaemic heart disease or structural pathology.

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  • Missed arrhythmia
  • Undiagnosed AF
  • Palpitations misdiagnosis
  • CPR Part 35
what we cover

Palpitations and the legal questions they raise in clinical negligence.

Palpitations are a common presentation in primary care and emergency departments, often dismissed as benign. They may, however, signal an underlying arrhythmia, structural heart disease or ischaemic pathology. Our cardiologists assess whether the clinical evaluation met the standard expected under Bolam and Bolitho, and whether earlier diagnosis would have altered the outcome.

Most instructions arise where palpitations were attributed to anxiety or benign extrasystoles without appropriate investigation. The decisions are tested against the current NICE and ESC guidance for arrhythmia and palpitations assessment. Where an underlying cardiac cause was missed, causation turns on whether timely intervention would have prevented the subsequent event.

  • Breach questions address whether the history and examination warranted an ECG, ambulatory monitoring or echocardiography, and whether the threshold for cardiology referral was met under current guidance.
  • Causation questions turn on whether earlier diagnosis of an underlying arrhythmia or structural pathology would, on the balance of probabilities, have prevented the subsequent event — such as stroke in undiagnosed atrial fibrillation or sudden cardiac death in Wolff-Parkinson-White syndrome. A missed myocardial infarction may also arise where ischaemia was overlooked.
  • Documentation is frequently in issue: whether the clinical record reflects the history taken, the differential considered, and the rationale for not pursuing further investigation.
  • Inquests may follow a sudden death where palpitations were the presenting symptom. Our consultants prepare reports on whether the clinical assessment met the standard expected, and whether earlier intervention would have altered the outcome.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether the history of palpitations was assessed for red-flag features — syncope, chest pain, family history of sudden death, or exertional symptoms — warranting urgent investigation.
  • Whether a resting ECG, ambulatory monitoring (Holter or event recorder) or echocardiography was appropriately requested and interpreted in line with current standards.
  • Whether the threshold for cardiology referral was met and acted on within a reasonable timeframe, including same-day referral where high-risk features were present.
  • Whether, on the balance of probabilities, earlier diagnosis of an underlying arrhythmia or structural pathology would have altered the outcome, with material contribution analysis where pre-existing disease is in issue.
  • Whether the clinical record reflects the history taken, the differential considered, and the rationale for not pursuing further investigation — a frequent point of contention in these claims.
Out of scope

Not covered without separate instruction

Common cases

Common scenarios we report on.

These patterns recur in palpitations misdiagnosis claims, most turning on primary care or emergency department decisions.

  • Primary care · Misattribution

    Palpitations attributed to anxiety without cardiac investigation

    Patient presented to the GP with recurrent palpitations, dizziness and near-syncope. Symptoms were attributed to anxiety without an ECG or cardiology referral, and a subsequent stroke revealed underlying atrial fibrillation. The report addresses whether the history described red-flag features warranting urgent investigation, and whether earlier anticoagulation would have prevented the stroke.

    Often paired with: Breach of Duty Causation

  • A&E · Triage

    Exertional palpitations dismissed as benign in A&E

    Patient presented to A&E with exertional palpitations and chest tightness. The resting ECG showed pre-excitation; the patient was discharged without cardiology review or ambulatory monitoring, and sudden cardiac death followed days later due to undiagnosed Wolff-Parkinson-White syndrome. The report examines whether the symptom pattern and ECG findings warranted admission and urgent electrophysiological assessment.

    Often paired with: Breach of Duty Causation

  • Primary care · Documentation

    Inadequate history recorded in palpitations presentation

    Patient presented to the GP with palpitations; the clinical record noted “anxiety” without documenting the duration, triggers, associated symptoms or family history. Subsequent syncope led to a diagnosis of long QT syndrome. The report addresses whether the history taken met the standard expected, and whether earlier diagnosis would have altered management.

    Often paired with: Screening & Merits Breach of Duty

  • Delayed referral

    Palpitations with red-flag features — delayed cardiology referral

    Patient presented with palpitations, syncope and a family history of sudden death. The GP referred routinely to cardiology and the waiting time exceeded 12 weeks; sudden cardiac death occurred before the appointment. The report tests whether the referral threshold met the accepted standard, and whether earlier intervention would have altered the outcome.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with causation often the central battleground.

Approaching a deadline?

Instruct an expert in a missed palpitations cause.

Send a short note on the alleged failings with the records bundle. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.

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