Peer Reviewed
Feature Article Cardiovascular medicine
Investigation of cardiac arrhythmias: predict, wait or provoke?
Abstract
In patients with a suspected cardiac arrhythmia, the goal of investigation is to record an ECG of the arrhythmia. However, as many arrhythmias are episodic, this may be a challenge. Strategies for diagnosis include predicting the arrhythmia from the history and risk factors, waiting for an episode (e.g. ambulatory ECG monitoring) and provoking an episode (e.g. stress testing).
Key Points
- Patients with arrhythmias can have a range of presentations, including palpitations, syncope or presyncope, breathlessness and fatigue, stroke and cardiac arrest.
- In patients with palpitations, distinguishing true cardiac arrhythmia from increased awareness of the heart beat is important.
- Recording an ECG (12-lead if possible) during an episode of symptoms is essential.
- The frequency, duration and severity of episodes of symptoms determine the best noninvasive investigation.
- Patients with syncope or palpitations and known structural heart disease are at risk of sudden death due to ventricular fibrillation or tachycardia and should be referred urgently for cardiac investigation.
Picture credit: © Brian Evans/Science Source/Diomedia.com
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