Irregular heart rhythms

Irregular heart rhythms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

• Patients with a conscious, unpleasant awareness of their heartbeat.

Differential Diagnosis

In alphabetical order.

• Atrial fibrillation
• Atrial flutter with variable block
• Bradyarrhythmias
• Extrasystoles
• Multifocal atrial tachycardia
• Paroxysmal atrial tachycardia
• Premature atrial contractions
• Premature ventricular contractions
• Sinus arrhythmia
• Wandering atrial pacemaker

Diagnosis

History and Symptoms

• Palpitations
• Dyspnea
• Chest pain
• Syncope
• Lightheadedness

Laboratory Findings

• Complete blood count (CBC)
• Calcium
• Pulse oximetry
• Arterial blood gases (ABG)
• Blood urea nitrogen (BUN) / creatinine
• Cardiac enzymes
• Toxicology screen
• Thyroid stimulating hormone (TSH)

Electrolyte and Biomarker Studies

• Electrolytes

Electrocardiogram

• ECG with rhythm strip

Chest X Ray

• Chest X-ray

Echocardiography or Ultrasound

• Echocardiogram may be necessary
• Transesophageal echocardiography more sensitive than transthoracic echocardiography

Treatment

• Administration of supplemental oxygen
• Hemodynamic stability
• Cardioversion
• Radiofrequency ablation

Acute Pharmacotherapies

• Adenosine
• Anti-arrhythmic medications
• Beta-blockers
• Calcium channel blockers
• Coumadin
• Digoxin

See Also

• Normal sinus rhythm
• Cardiac arrhythmia