Approach to Palpitations

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Presentation transcript:

Approach to Palpitations Tom Wallace, MD Cardiac Electrophysiologist CHI St. Vincent Heart Clinic Arkansas

Approach to Palpitations Sinus pauses and heart block Sinus Tachycardia Atrial dysrhythmias Ventricular dysrhythmias

Sinus Tachycardia Secondary causes (Stressors) Fever / infection Volume depletion Hyperthyroidism Anemia Dieting

Sinus Tachycardia Inappropriate sinus tachycardia Not common Difficult to treat

Atrial beats that arise from areas of the atria not the sinus node

Ventricular beats right ventricle endocardium left ventricle epicardium apex outflow tract

Supraventricular Tachycardia Atrial Tachycardia Atrial Flutter Atrial Fibrillation Accessory Pathway Wolff Parksinson White Atrio-Ventricular Reentrant Tachycardia

Ventricular Tachycardia Structurally abnormal hearts Ischemic cardiomyopathy (scar mediated) Nonischemic cardiomyopathy Arrhythmogenic Right Ventricular dysplasia Structurally normal hearts Outflow tract origin (right or left ventricle and Aorta) Long QT syndrome, catecholaminergic VT Short QT, Brugada Syndrome

Diagnostics 12 Lead ECG 24-48 Holter monitoring 30 day event monitoring Echocardiogram Exercise stress testing Electrophysiology Study

Treatments Address secondary causes Beta blocker or calcium channel blockers Antiarrhythmic medications Catheter ablation