cardiac arrhythmia
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Introduction
Irregularity or loss of rhythm of the heartbeat.
Etiology
- heart disease
- unmodifiable factors
- genetics, older age
- modifiable risk factors
- pharmaceutical agents:
History
- onset, regularity, duration & pattern of discontinuance*
- dyspnea
- chest pain
- syncope, near-syncope or lightheadedness
- preciptitating or exacerbating factors
- familial or congenital arrhythmias
- comorbidities
- conduction system disease
- inflammatory disease
- endocrinopathy
- infection
* patterns
- arrhythmias that start & terminate abruptly are generally due to re-entry
- an arrhythmia that starts & stops more gradually generally results from increased automaticity
Physical examination
- pulse rate & regularity
- orthostatic blood pressure
- presence of murmurs
- presence of S3 gallop
- paradoxical or fixed splitting of S2
- during the arrhythmia
- indicators of AV synchrony
- intermittent cannon A waves in jugular venous pulsation
- variable intensity of S1
- variable peak systolic blood pressure
- effect of vagal maneuvers
- indicators of AV synchrony
Clinical manifestations
- symptoms may include:
- palpitations
- lightheadedness
- shortness of breath or dyspnea on exertion
- syncope or presyncope
- angina pectoris
- sudden cardiac death
Laboratory
Diagnostic procedures
- electrocardiogram (EKG)
- HOLTER if arrhythmia intermittent but occurs at least daily
- event recorder if arrhythmia is symptomatic but infrequent, i.e. syncope
- programmed electrical stimulation (electrophysiologic study) is useful for catheter ablation of arrhythmogenic foci
Management
- treatment & prognosis depend on whether structural heart disease is present
- inpatient initiation of antiarrhythmic therapy
- all patients who present with a hemodynamically unstable arrhythmia
- antiarrhythmic agents other than amiodarone in patients with structural heart disease, especially with LV ejection fraction < 40%
- outpatient initiation of antiarrhythmic therapy
- normal cardiac function & absence of hemodynamically compromising arrhythmia
- amiodarone
More general terms
More specific terms
- atrioventricular (AV) dissociation
- atrioventricular reciprocating tachycardia (AVRT)
- bigeminy
- bradyarrhythmia (bradycardia)
- cardiac conduction re-entry
- chronic cardiac arrhythmia
- heart block
- premature electrocardiography complex
- pulseless electrical activity; electromechanical dissociation (PEA)
- supraventricular arrhythmia
- tachyarrhythmia (tachycardia)
- trigeminy
- ventricular arrhythmia
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 138
- ↑ 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
- ↑ Zimetbaum P, Goldman A. Ambulatory arrhythmia monitoring: choosing the right device. Circulation. 2010 Oct 19;122(16):1629-36 PMID: https://pubmed.ncbi.nlm.nih.gov/20956237
- ↑ Epstein AE, DiMarco JP, Ellenbogen KA et al 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013 Jan 22;127(3):e283-352. PMID: https://pubmed.ncbi.nlm.nih.gov/23255456
- ↑ AHA SCIENTIFIC STATEMENT. Tisdale JE et al Drug-Induced ArrhythmiasA Scientific Statement From the American Heart Association. Circulation. 2020, 142:00-00. September 19. https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000905
- ↑ National Heart, Lung, and Blood Institute (NHLBI) Arrhythmia: https://www.nhlbi.nih.gov/health-topics/arrhythmia