Introduction: To evaluate the usefulness of a handheld echocardiograph (HHE) for the assessment of cardiac abnormalities in patients complaining of palpitations. Methods: We assessed the following parameters using HHE (V scan, GE) by a trained junior cardiologist and independently by a trained cardiologist on a standard echo machine (SEM, Aloka) in a blinded fashion, using a severity score: left atrial (LA) size, valvular abnormalities (VA), wall motion abnormalities (WMA) and left ventricular systolic function (LVEF). The degree of agreement was assessed by kappa correlation. Results: 64 consecutive patients with a mean age of 45 ± 13.2 years were included over a 3 month period. Atrial fi brillation (AF) was identifi ed in 25 (39%). Increased LA size was found by HHE in 20 (80%) of the AF patients. The correlation between HHE and SEM was very good (kappa > 0.8) for LA size and presence of VA and moderate for WMA and LVEF (kappa > 5). Conclusions: The initial immediate screening with a HHE is helpful in the evaluation of chamber size and associated valvular abnormalities in patients with palpitations.