Palpitations are a common presentation in primary care and often cause significant anxiety and concern for patients. This chapter provides a comprehensive overview of the underlying causes of palpitations, which range from benign to potentially serious medical conditions. It aims to guide clinicians through a structured approach that includes thorough patient assessment and the appropriate use of diagnostic tools such as electrocardiograms and targeted laboratory tests. Additionally, the chapter outlines key management strategies, including the identification and handling of red flag symptoms, as well as indications for further intervention in cases involving underlying cardiac pathology.