Although mostly arrhythmias are symptomatic, sometimes they may not produce any symptoms. Some serious arrhythmias like atrial fibrillation can be asymptomatic and present with stroke (AFincreases chance of stroke by 500%), while not so harmful arrhythmias like premature beats can be very symptomatic. So when we are deciding about severity of any arrhythmias, asymptomatic status may not imply severity of disease process. The presenting signs can be -
The risk factors of SCA are:
Diagnosing cardiac arrhythmias can be difficult, because of the infrequent episodes, and by the time patient reaches the doctor, arrhythmia may subside, making it difficult to identify exact nature of arrhythmia. So, if the patient doesn’t have documented arrhythmia, then history, physical examination and when required various investigations may be required to diagnose the arrhythmia.
In history taking the exact nature of arrhythmia is assessed by asking the patient to describe the exact mode of onset of symptoms, ask them to explain how they feel the palpitations, any precipitating or relieving factors. Some arrhythmias come with sudden onset of neck pulsations. Some patients may develop arrhythmias during particular time of the day, sometimes during the exercise, which may help in diagnose the exact nature of arrhythmia. There are arrhythmias which are relieved by pressure over the neck, applying cold water to face,these may help the doctor to clinch the diagnosis. Presence of other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems, History of lung diseases including tuberculosis. may also be important to know to diagnose and to decide on further management.It is also important to know about the family’s medical history, including whether anyone in the family has:
History previous medications and current medications are also important. History of smoking, physical exercise and intake of drugs like cocaine or amphetamine will also be enquired.
The following things will be assessed during the physical examination
An arrhythmia is considered documented if it can be recorded on an electrocardiogram (ECG). This is the standard clinical tool for diagnosing arrhythmias. To do an ECG, the healthcare professional places small patches or stickers called electrodes on different parts of the body. One is put on each arm and leg and several across the chest. They do not hurt. With various combinations of these electrodes, different tracings of the heart’s electrical activity can be made and permanently recorded on paper or in a computer. It records the relative timing of atrial and ventricular electrical events. It can be used to measure how long it takes for impulses to travel through the atria (the heart’s upper chambers), the atrioventricular (AV) conduction system and the ventricles (the heart’s two lower, pumping chambers). Because of the fleeting nature of arrhythmias, a person who complains of symptoms that suggest arrhythmia may often have an ECG that appears normal. Hence it is advisable to do an ECG when symptoms occur. Also it is very important to preserve all ECGs, keeping photocopied or electronically stored to avoid fading, and bringing them to the electrophysiologist during evaluation.
Suspected arrhythmias sometimes may be documented by using a small, portable ECG recorder, called a Holter monitor (or continuous ambulatory electrocardiographic monitor). This can record 24 hours of continuous electrocardiographic signals. While an ECG is sort of a 12-second “snapshot” of the heart’s electrical activity, the Holter monitor is more like a “movie.”
As with an ECG, electrodes are taped to the chest. The wires are connected to a portable, battery-operated recorder that can run for 24 to 48 hours. The patient can do most normal activities while being tested. The patient may need to keep a diary or log of your activities and symptoms.
At the end of the measurement period, the recorder’s tape or memory is analyzed on a computer that rapidly identifies rhythm disturbances that occurred while you were wearing the monitor. The diary helps the healthcare professional see how the activities or symptoms correspond to recorded events in the heart. For suspected arrhythmias that occur less frequently than every day, an External Loop recorder or ELR is helpful. An event monitor is similar to a Holter monitor. The patient must wear an event monitor while doing the normal activities. An event monitor records the heart’s electrical activity when the patient will push a button to start the monitor on feeling symptoms. Otherwise they record automatically when they sense abnormal heart rhythms. Patient can wear an event monitor for weeks up to a month.
If the symptoms of palpitation or syncope is rare to occur once in few months, those patients are monitored by an Implantable loop recorder. This device detects abnormal heart rhythms. Small nick in skin is used to place this device under the skin in the chest area.
Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having arrhythmia.
is important to detect gene defects that cause primary electrical problems of the heart as a result of defect of ion channels (channelopathies), or to detect genetic cardiac muscle diseases. These help to know the familial gene defects, which helps in prognostication and family planning.
A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged.
Treatments
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2020
This course is designed totrain Cardiologists in the sub-speciality of Cardiac Pacing and Electrophysiology. This will equip them to work as trained Cardiac Electrophysiologists capable of handling paediatric and adult rhythm abnormalities.
This course is designed totrain Cardiologists in the sub-speciality of Cardiac Pacing and Electrophysiology. This will equip them to work as trained Cardiac Electrophysiologists capable of handling paediatric and adult rhythm abnormalities.
This course is designed totrain Cardiologists in the sub-speciality of Cardiac Pacing and Electrophysiology. This will equip them to work as trained Cardiac Electrophysiologists capable of handling paediatric and adult rhythm abnormalities.