EVALUATION OF SUSPECTED CARDIAC ARRHYTHMIA

Course overview

THREE GOALS SHOULD BE KEPT IN MIND WHEN APPROACHING A PATIENT WITH SUSPECTED CARDIAC ARRHYTHMIA. THESE INCLUDE UNDERSTANDING SYMPTOMS TYPICALLY ASSOCIATED WITH CARDIAC ARRHYTHMIAS, DECIDING WHETHER THE PATIENT HAS POTENTIAL RISKS OF DYING FROM AN ARRHYTHMIA, AND CHOOSING THE CORRECT MEANS OF DOCUMENTING THE SUSPECTED RHYTHM DISORDER. ESTABLISHING A PROBABLE CAUSE OF AN ARRHYTHMIA REFERS TO THE LIKELIHOOD THAT AN ARRHYTHMIA EXISTS AND IS BASED ON CERTAIN SYMPTOMS OBTAINED IN THE HISTORY. AN IN-DEPTH RISK ASSESSMENT IS UNDERTAKEN IF THERE IS A REASONABLE CONCERN THAT DEATH MAY BE AN OUTCOME. THIS IS LARGELY BASED ON A FAMILY HISTORY OF SUDDEN DEATH, EVIDENCE OF STRUCTURAL HEART DISEASE, OR, IN THE CASE OF THE PRIMARY ARRHYTHMIA SYNDROMES, UNIQUE ECG ABNORMALITIES. MAKING THE DIAGNOSIS MEANS DOCUMENTING THE ARRHYTHMIA AND, IN PARTICULAR, LINKING IT TO THE PATIENT'S SYMPTOMS. THE BEST WAY TO DO THIS IS TO PROVIDE SOME FORM OF AMBULATORY MONITORING THAT BRINGS THE TWO TOGETHER. THIS ARTICLE OUTLINES THE VARIOUS SYMPTOMS OF CARDIAC ARRHYTHMIAS, AND THEIR PATHOPHYSIOLOGIC BASIS, PROVIDES GUIDANCE IN MAKING A RISK ASSESSMENT AND DISCUSSES THE VARIOUS MEANS OF REACHING THE CORRECT DIAGNOSIS. IT HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN CARING FOR PATIENTS EXPERIENCING ARRHYTHMIAS.