Heart Rhythm Disorders (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- How does the heart work?
- Premature atrial contractions (PACs) and premature ventricular contractions (PVCs)
- Sinus tachycardia
- Sinus bradycardia
- Abnormal heart rhythms
- Ventricular fibrillation
- Ventricular flutter
- Paroxysmal supraventricular tachycardia (PSVT)
- Wolf-Parkinson-White Syndrome
- Atrial fibrillation
- Atrial Flutter
- Heart blocks
- When should I seek medical care?
- How are heart rhythm disorders diagnosed?
- What is the treatment for heart rhythm disorders?
- Can heart rhythm disorders be prevented?
- Find a local Cardiologist in your town
When to seek medical care
Unexplained palpitations are not normal, especially when associated with shortness of breath, sweating, feelings of chest pressure, or passing out. The person should be made comfortable and laid flat, and EMS (emergency medical service) should be activated by calling 911 or the emergency number in your area.
If the person is unconscious unresponsive, life support measures including CPR if necessary should be undertaken following the American Heart Association guidelines.
If the episode is short-lived and resolves spontaneously, the primary care provider should be contacted urgently to seek advice.
If the episode is a recurrent problem, the diagnosis is known, and the rhythm disturbance resolves itself, then a less urgent call to the primary care provider is warranted.
It is reasonable to seek emergent medical care any time that a heart rhythm disturbance occurs or there is concern that a heart problem is present.
How are heart rhythm disorders diagnosed?
The mainstay of diagnosis remains the EKG and heart rhythm monitoring. These are often done immediately in the ambulance or upon arrival in the emergency department. Unfortunately, in many patients, the palpitations or symptoms have resolved, and no acute rhythm abnormalities can be found.
Depending on the associated symptoms and the history, observation and monitoring of the heart may occur in hospital or as an outpatient. In patients who are syncopal, meaning that they passed out, and it cannot be explained by a benign diagnosis like vasovagal syncope, admission to the hospital often occurs. Those patients with chest pain and shortness of breath may also be admitted to evaluate their heart; otherwise, monitoring devices (for example, a Holter monitor) that can measure heart rates and rhythms for 24 or 48 hours or longer (up to one month or more) are used. In some instances, rhythm identification is elusive and may take months or years to capture and identify.
If the rhythm is known, then tests to identify potential causes may be done. These are dependent on the specific rhythm abnormality and can range from blood tests to lung evaluations and sleep studies to echocardiograms and electrophysiologic testing.
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