Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cardiac disease

Other diagnostic factors

  • medications
  • palpitations
  • fatigue, weakness
  • chest pain
  • shortness of breath, cough
  • nausea, vomiting
  • light-headedness, syncope
  • rales
  • oedema

Risk factors

  • coronary artery disease
  • substance misuse (alcohol ingestion/withdrawal, cocaine, amfetamines)
  • digoxin toxicity
  • exacerbation of chronic lung disease
  • previous cardiac surgery to correct congenital heart defects

Diagnostic investigations

1st investigations to order

  • ECG
  • digoxin level
  • theophylline level
  • CXR
  • electrolytes
  • toxicology screen
Full details

Investigations to consider

  • vagal manoeuvres, adenosine
  • thyroid-stimulating hormones
  • echocardiogram
  • ambulatory 24-hour (Holter) ECG or event recorder
  • electrophysiological study (EPS)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Department of Emergency Medicine

University of North Carolina

Chapel Hill

NC

Disclosures

SS declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Emergency Medicine

University of Maryland Medical Center

Baltimore

MD

Disclosures

AM declares that he has no competing interests.

Consultant Cardiologist

Royal Brompton & Harefield NHS Trust

Imperial College London

London

UK

Disclosures

VM declares that he has no competing interests.

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