This chapter, written for undergraduate medical students and post-graduate doctors in training, presents information on how to manage palpitations — a case which they are likely to encounter in the future in a general practice setting. It presents the case of a 48-year-old woman who has noticed some palpitations over the last few weeks. She tells the general practitioner (GP) that these can come on at any time, but particularly when she is tired and at night when she is going to sleep – she feels as if her heart is leaping in her chest. The chapter provides details of the patients' medical history and the key findings of clinical examination, together with initial investigation results data for evaluation, and helps them develop their skills of clinical reasoning. Key questions then prompt the student to evaluate the patient, and reach a decision regarding their condition and the possible treatment plan.