Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • pulse rate <50 bpm
  • age >70 years
  • use of known causative medications
  • presence of known underlying cause
  • dizziness/lightheadedness
  • syncope
  • fatigue
  • exercise intolerance
  • shortness of breath
  • cannon a-waves in jugular venous pulse
  • jugular venous distension

Other diagnostic factors

  • increased intracranial pressure
  • abnormal heart sounds
  • abdominal or lower extremity edema
  • hypotension
  • mental status changes
  • pallor
  • extremities cool to touch
  • hypothermia
  • chest pain

Risk factors

  • use of known causative medications
  • age >70 years
  • recent myocardial infarction
  • surgery
  • hypothyroidism
  • electrolyte disorders
  • infections
  • exposure to toxins
  • infiltrative diseases
  • sleep apnea

Diagnostic investigations

1st investigations to order

  • 12-lead ECG
  • Holter monitoring
  • event monitor
  • exercise testing
  • carotid sinus massage
  • echocardiogram
  • thyroid function tests
  • basic metabolic panel
  • cardiac markers
  • serum digoxin level
  • serum creatinine
Full details

Investigations to consider

  • implantable-loop recorder
  • tilt-table testing
  • electrophysiology testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Brian Olshansky

Professor Emeritus

University of Iowa

Iowa City

Adjunct Professor

Des Moines University

Electrophysiologist

Mercy North Iowa

Mason City

Covenent Hospital

Waterloo

IA

Disclosures

BO is a national research study coordinator for Boehringer Ingelheim and is on the data safety monitoring board for Amarin. He is a consultant and speaker for Lundbeck and On-X.

Rakesh Gopinathannair

Director of Cardiac Electrophysiology

Assistant Professor of Medicine

Division of Cardiovascular Medicine

University of Louisville School of Medicine and Jewish Hospital

Louisville

KY

Disclosures

RG is a consultant for St. Jude Medical and Boston Scientific. He is on the speakers’ bureau for American Heart Association, Pfizer Inc., Bristol Myers Squibb, and Zoll Medical. He serves on the advisory board of HealthTrust PG.

Professor Brian Olshansky and Dr Rakesh Gopinathannair would like to gratefully acknowledge Dr Renee M. Sullivan, Dr Weiwei Li, Dr Alexander Mazur, and Dr Chirag M. Sandesara, previous contributors to this monograph. RMS, WL, AM, and CMS declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Clinical Medicine

University of California

Chief

Clinical Cardiology

San Francisco General Hospital

Director

Coronary Care Unit

ECG Laboratory and Pacemaker Clinic

San Francisco

CA

Disclosures

NG declares that she has no competing interests.

Associate Professor of Medicine

Stanford University

Stanford

CA

Disclosures

PH declares that he has no competing interests.

Cardiology Center and Medical Polyclinics

University Hospital Geneva

Geneva

Switzerland

Disclosures

JMS declares that he has no competing interests.

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