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Three goals should be kept in mind when approaching a patient with suspected cardiac arrhythmia. These include understanding symptoms typically associated with cardiac arrhythmias, deciding whether the patient has potential risks of dying from an arrhythmia, and choosing the correct means of documenting the suspected rhythm disorder. Establishing a probable cause of an arrhythmia refers to the likelihood that an arrhythmia exists and is based on certain symptoms obtained in the history. An in-depth risk assessment is undertaken if there is a reasonable concern that death may be an outcome. This is largely based on a family history of sudden death, evidence of structural heart disease, or, in the case of the primary arrhythmia syndromes, unique ECG abnormalities. Making the diagnosis means documenting the arrhythmia and, in particular, linking it to the patient's symptoms. The best way to do this is to provide some form of ambulatory monitoring that brings the two together. This article outlines the various symptoms of cardiac arrhythmias, and their pathophysiologic basis, provides guidance in making a risk assessment and discusses the various means of reaching the correct diagnosis. It highlights the role of the interprofessional team in caring for patients experiencing arrhythmias. Objectives: Outline the three main goals when approaching the patient with suspected arrhythmia. Explain how sustained low heart rates affect cardiac output and blood pressure, whether due to sinus bradycardia or AV block with rates in the 30 to 50 bpm ranges. Describe how tachyarrhythmias affect blood pressure, particularly those with an abrupt onset and rates exceeding 160 to 180 beats per minute. Summarize the three types of ambulatory monitoring devices and comment on when one might choose one over the other. Access free multiple choice questions on this topic.

The different clinical presentations of cardiac arrhythmias reflect either reduced blood pressure or cardiac output, or both, as a direct result of the rhythm abnormality. Unlike most chronic diseases, hypertension, for example, rhythm disorders frequently behave intermittently, in an all-or-none fashion, chronic persistent or permanent atrial fibrillation being the major exception. The impact of an arrhythmia is usually only evident during the arrhythmia. Symptoms of arrhythmia could be most pronounced at the onset or the termination of an intermittent arrhythmia. While an underlying chronic disease may be continuously present, any arrhythmia caused by it usually emerges entirely randomly and unpredictably. Although symptoms and their severity vary considerably, the consequence of a rhythm disturbance tends to be rather binary: nuisance or death. For patient safety, our strategy should focus initially on the latter. Fortunately, the majority of arrhythmias fall within the nuisance category. Atrial fibrillation remains the exception: it can be present continuously, and significant consequences lie between nuisance and death, such as stroke and heart failure. The approach outlined here is a suggested one. The very first encounter with an arrhythmia patient could be someone handing you a rhythm strip wherein no clinical information is available. We should keep three goals in mind while approaching a patient with suspected arrhythmia. Once completed, we can initiate a treatment strategy. Establish probable cause that an arrhythmia exists Determine whether there may be a risk of dying Document the arrhythmia Establishing probable cause refers to the likelihood that an arrhythmia exists and is based mainly on symptoms. A risk assessment is undertaken if there is a reasonable concern that death may be an outcome because of a personal history of structural heart disease, a family history of sudden death, or, in the case of primary arrhythmia syndromes, unique ECG abnormalities. An asymptomatic arrhythmia should not preclude the need for a risk assessment.

Establishing probable cause refers to the likelihood that an arrhythmia exists and is based mainly on symptoms. A risk assessment is undertaken if there is a reasonable concern that death may be an outcome because of a personal history of structural heart disease, a family history of sudden death, or, in the case of primary arrhythmia syndromes, unique ECG abnormalities. An asymptomatic arrhythmia should not preclude the need for a risk assessment. Making the diagnosis means documenting the arrhythmia and, in particular, linking it to the patient's symptoms via some form of ambulatory monitoring. Alternatively, one can pursue an electrophysiology study (EPS) to elicit or provoke a sustained arrhythmia if it doesn't occur spontaneously and is felt to place the patient at risk. The EPS may be the only means to discover abnormalities in the conduction system, such as a prolonged HV interval, that would never be obvious from an ECG tracing. Such findings are usually associated with bradyarrhythmias.

One of the more relevant team members working toward a common goal is the technician responsible for providing the ambulatory monitor. This individual has the important responsibility of educating the patient about the operation of the recorder and providing assistance when needed to ensure that the information provided by the device is complete.