Irregular Heart Rhythms

Irregular Heart Rhythms: Excerpt from In a Page: Signs and Symptoms

The patient should be asked to describe the heart rhythm and to demonstrate it by either saying or tapping the speed and rhythm of the sensation. Additionally, teaching the patient to measure his or her pulse during the episode may give more clues as to the etiology of the sensation of an irregular rhythm. All complaints of irregular heart rhythms should be investigated to ensure that the arrhythmia is not life threatening.

Differential Diagnosis

• Atrial fibrillation
  –One of the most common causes of irregular rhythm
  –Narrow QRS complex without organized atrial contraction (no P waves)
  –Etiologies include infection, thyrotoxicosis, alcohol, cocaine, amphetamines, myocarditis, pericarditis, hypertensive crisis, ischemia, MI, CHF, hypoxia, PE, hypertension, valvular heart disease
• Atrial flutter with variable block
  –Narrow QRS complex
  –ECG: “Sawtooth” flutter waves
  –Atrial rate is typically 250–350 bpm
  –Ventricular rate is usually 1/2 or 1/3 of atrial rate (2:1 or 3:1 block)
  –Irregular when variable block is present
  –Result of a macro-reentrant circuit in atrium

• Premature atrial contractions
• Paroxysmal atrial tachycardia
• Multifocal atrial tachycardia
  –Multiple areas of atrial impulses (more than three P wave morphologies) followed by a narrow QRS complex
  –HR ≥ 100 bpm
  –Most often seen in patients with lung disease
• Wandering atrial pacemaker
  –Multiple areas of atrial impulses (more than three P wave morphologies) followed by a narrow QRS complex
  –HR ≤ 100 bpm
  –Often occurs in athletes and the very young (increased vagal tone)

• Premature ventricular contractions
• Sinus arrhythmia

Workup and Diagnosis

• History and physical examination
  –Associated symptoms may include lightheadedness,
  palpitations, dyspnea, chest pain, or syncope
  –Assess for hemodynamic instability

Treatment

• Ensure hemodynamic stability
• Administer supplemental O₂
• Rate control may be achieved via adenosine, digoxin, β-blockers, calcium channel blockers, and other pharmacotherapeutics

Atrial fibrillation: Treated by rate control, anticoagulation for stroke prevention, and/or restoration/maintenance of sinus rhythm
–Rate control: β-blockers, calcium channel blockers
–Anticoagulation: Long-term coumadin in appropriate patients
–Restoration/maintenance of sinus rhythm: Antiarrhythmic medications, cardioversion

• Atrial flutter
  –Rate control is initial goal of therapy
  –Anticoagulation is controversial
  –Cardioversion to terminate rhythm
  –Radiofrequency ablation may be curative

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Heart conditions

• Back to disease: Heart conditions: Introduction
• Next Book Extract About Heart conditions: Murmurs - Diastolic (In a Page: Signs and Symptoms)
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• CARDIAC MURMURS
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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• CARDIAC ARRHYTHMIA
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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• Gallops & Extra Heart Sounds
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Irregular Heart Rhythms
• "In a Page: Signs and Symptoms" (2004)
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• Murmurs - Diastolic
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Murmurs - Systolic
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Abnormal Heart Sounds
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Heart Failure
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• MURMURS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• CARDIAC ARRHYTHMIAS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• Murmurs
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Pulse rhythm abnormality
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Congestive Heart Failure
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Heart Murmurs*
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Cardiac Arrest (Sudden Cardiopulmonary Collapse)
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Valvular heart disease
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Cardiac arrest, ventricular fibrillation
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Cardiac arrhythmias
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Cardiac tamponade
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Heart failure
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Rheumatic fever and rheumatic heart disease
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Murmurs
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Pulse rhythm abnormality
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Heart Murmur, Diastolic
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Heart Murmur, Systolic
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Congestive Heart Failure
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Cardiomegaly/Congestive Heart Failure
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Discrete Heart Sounds
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Diastolic Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Systolic Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Continuous Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Valvular heart disease
• "Handbook of Diseases" (2003)
• [ read ]

• Cardiac arrhythmias
• "Handbook of Diseases" (2003)
• [ read ]

• Cardiac tamponade
• "Handbook of Diseases" (2003)
• [ read ]

• Heart failure
• "Handbook of Diseases" (2003)
• [ read ]

• Rheumatic fever and rheumatic heart disease
• "Handbook of Diseases" (2003)
• [ read ]

• Murmurs
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Murmurs
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Heart Murmurs (Asymptomatic)
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Cardiac Failure
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Murmurs
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• MURMURS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• CARDIAC ARRHYTHMIAS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• Do not forget to prescribe prophylaxis against endocarditis for patients with heart disease
• "Avoiding Common Pediatric Errors" (2008)
• [ read ]

• Give ketamine in patients with significant cardiac disease or sepsis
• "Avoiding Common Pediatric Errors" (2008)
• [ read ]

• Learning Problems
• "The 5-Minute Pediatric Consult" (2008)
• [ read ]

• Speech Problems
• "The 5-Minute Pediatric Consult" (2008)
• [ read ]

 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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• Murmurs - Diastolic (In a Page: Signs and Symptoms)
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