Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age >50-60 years
  • syncope
  • pre-syncope
  • heart rate <40 bpm

Other diagnostic factors

  • male sex
  • fatigue
  • dyspnoea
  • chest pain, palpitations, and nausea or vomiting
  • high (less commonly, low) blood pressure
  • cannon A waves
  • hypoxaemia
  • Fhx of AV block
  • features of Lyme disease

Risk factors

  • age-related degenerative changes in the conduction system
  • increased vagal tone
  • AV-nodal blocking agents
  • chronic stable CAD
  • acute coronary syndrome
  • CHF
  • hypertension
  • cardiomyopathy
  • left ventricular hypertrophy
  • recent cardiac surgery
  • acid-base or electrolyte disturbance
  • neuromuscular disorders
  • sarcoidosis
  • myocarditis
  • infective endocarditis
  • hypoxemia

Diagnostic investigations

1st investigations to order

  • 12-lead ECG
  • serum troponin
  • serum potassium
  • serum calcium
  • serum pH
  • serum digitalis level
Full details

Investigations to consider

  • 24-hour ambulatory monitoring or event monitoring
  • chest x-ray
  • transthoracic echocardiogram
  • serological testing for Lyme disease
  • implantable loop recording
  • tilt-table testing
  • electrophysiological study
  • cardiac stress testing
  • coronary angiography
  • serum CK-MB
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Cardiologist/Electrophysiologist

Royal Wolverhampton NHS Trust

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

Disclosures

SP has received speaker's honoraria from Bayer, Bristol-Myers Squibb, MSD, and Pfizer. SP has received hospitality and/or accommodation from Bayer, Medtronic, St Jude, and Boston Scientific for attending conferences or meetings.

EP and Devices Fellow

New Cross Hospital

Wolverhampton

UK

Disclosures

JP declares that he has no competing interests.

Dr Petkar and Dr Pathiraja would like to gratefully acknowledge the assistance of Dr Arka Das. Dr Petkar would also like to gratefully acknowledge Dr Susan S. Kim, Dr John F. Beshai, and Dr Stephen L. Archer, previous contributors to this monograph. AD, SSK, JFB, and SLA declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Section of Cardiology

Director

Cardiac Electrophysiology

University of Chicago Medical Center

Chicago

IL

Disclosures

BPK declares that he has no competing interests.

Associate Professor of Medicine

Section of Cardiology

Cardiac Electrophysiology

University of Chicago Medical Center

Chicago

IL

Disclosures

MCB declares that he has no competing interests.

Consultant Cardiologist

King’s College Hospital

London

UK

Disclosures

NG declares that he has no competing interests.

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