PULSE IRREGULARITY

Ask the Following Questions:

1. Is the rate normal, rapid, or slow? A rapid rate would suggest supraventricular tachycardia, ventricular tachycardia, atrial flutter, and fibrillation. A slow rate would suggest atrioventricular (AV) nodal rhythm, third-degree AV block, sinoatrial block, Wenckebach phenomena, and sick sinus syndrome. A normal rate would suggest atrial and ventricular premature contractions, AV dissociation, bigeminal rhythm, and controlled flutter or fibrillation.
2. If the rate is rapid, is it regular or irregular? A rapid regular rate would suggest supraventricular tachycardia or ventricular tachycardia, whereas a rapid irregular rate would suggest atrial flutter or fibrillation.
3. If the rate is slow, is it regular or irregular? A slow regular rhythm would suggest AV nodal rhythm, third-degree AV block, or sinoatrial block. A slow irregular rhythm would suggest Wenckebach phenomena or sick sinus syndrome.

DIAGNOSTIC WORKUP

Some physicians will want to refer the patient with a pulse irregularity to a cardiologist at the outset. Other clinicians would rather investigate the patient further.

Routine tests ordered include CBC, sedimentation rate, urinalysis, chemistry panel, serial cardiac enzymes, thyroid profile, ANA test, EKG, and chest x-ray with lateral and anterior oblique views. If there is fever, an ASO titer or streptozyme test should be done to rule out rheumatic fever, and blood cultures should be done to rule out bacterial endocarditis. If the EKG is normal and the symptoms are intermittent, 24-hr Holter monitoring should be done. The patient also can be hospitalized for a few days for telemetry. Newer technology includes using a continuous-loop event recorder to allow monitoring for 2 weeks at a time. Echocardiography will disclose valvular disease and myocardiopathies. His' bundle studies may be necessary in some cases. Also, angiography and catheterization studies should be considered in difficult cases. Before expensive tests are ordered, it is wise to consult a cardiologist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Heart rhythm symptoms: Introduction (review 1482 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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