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
Investigations to consider
- implantable-loop recorder
- tilt-table testing
- electrophysiology testing
Treatment algorithm
Contributors
Authors VIEW ALL
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.
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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