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The Arrhythmic Patient in the Emergency Department : A Practical Guide for Cardiologists and Emergency Physicians.

By: Contributor(s): Material type: TextTextPublisher: Cham : Springer International Publishing AG, 2016Copyright date: ©2016Edition: 1st edDescription: 1 online resource (214 pages)Content type:
  • text
Media type:
  • computer
Carrier type:
  • online resource
ISBN:
  • 9783319243283
Subject(s): Genre/Form: Additional physical formats: Print version:: The Arrhythmic Patient in the Emergency DepartmentDDC classification:
  • 616.128025
LOC classification:
  • RC666-701.2
Online resources:
Contents:
Intro -- Foreword -- Preface -- Contents -- 1: Management of Arrhythmic Patients in the Emergency Department: General Principles -- 1.1 Triage -- 1.2 Emergency Department Physician Approach to the Arrhythmic Patient -- 1.2.1 Tachyarrhythmia -- 1.2.1.1 Procedural Sedation/Anesthesia During Cardioversion -- 1.2.1.2 Cardioversion/Defibrillation -- 1.2.1.3 When should the Cardiology Consultant be called? -- 1.2.1.4 Treatment of a Wide-QRS Complex Tachycardia -- 1.2.2 Bradycardia -- 1.2.3 Sinus Bradycardia -- 1.2.4 Pitfalls -- 1.2.5 Low-Rate Atrial Fibrillation -- 1.2.6 Sinus Node Dysfunction: Sick Sinus Syndrome -- 1.2.7 Atrioventricular (AV) Blocks -- 1.2.8 First-Degree AV Block -- 1.2.9 Second-Degree AV Block Type I (Wenckebach: Mobitz I) -- 1.2.10 Higher Degree AV Blocks (Second-Degree AV Block Type II and Third-Degree AV Block) -- 1.2.11 Second-Degree AV Block Type II (Mobitz II) -- 1.2.12 Third-Degree AV Block -- 1.2.13 Accelerated Idioventricular Rhythm -- 1.2.14 Treatment: -- 1.2.15 Pitfalls -- 1.2.16 When Should the Consultant Cardiologist Be Called? -- 1.2.17 Definitive Pacemaker Indications -- 1.2.18 A Suggested Algorithm/Pathway for Diagnosis and Treatment -- References -- 2: Syncope: First Evaluation and Management in the Emergency Department -- 2.1 Epidemiology of Syncope -- 2.2 Costs of Syncope -- 2.2.1 Difficulties in the Management of Patients with Syncope in the ED -- 2.2.2 The Recommended Management of Syncope in the ED -- References -- 3: Management of Bradyarrhythmias in Emergency -- 3.1 Anatomy and Pathophysiology -- 3.2 Bradycardia -- 3.3 Sinus Node Dysfunction -- 3.3.1 Sinus Bradycardia -- 3.3.2 Sinus Arrest -- 3.4 Atrioventricular Block -- 3.4.1 First-Degree AV Block -- 3.4.2 Second-Degree AV Block -- 3.4.3 Atrioventricular Block with 2:1 Conduction -- 3.4.4 Advanced AV Block.
3.4.5 Low-Rate Atrial Fibrillation -- 3.4.6 Third-Degree AV Block -- 3.4.7 Interventricular Block -- 3.4.8 Atrioventricular Dissociation -- 3.4.9 Conduction Disturbances during Acute Myocardial Infarction -- 3.4.10 Cardiac Arrest and Sudden Cardiac Death -- 3.5 Treatment -- 3.5.1 Temporary Pacemaker -- 3.5.2 Permanent Pacemaker -- Bibliography -- 4: Supraventricular Arrhythmias in Emergency -- 4.1 What Physicians Working in ED Should Know -- 4.1.1 Patients in Unstable Condition -- 4.1.2 Patients in Stable Condition -- 4.1.3 Management -- 4.1.3.1 Narrow QRS -- 4.1.3.2 Wide QRS -- 4.2 What Cardiologists Should Know -- 4.2.1 Basic Electrophysiologic Principles -- 4.2.2 Mechanisms of Arrhythmias -- 4.2.2.1 Focal -- 4.2.2.2 Reentry -- 4.2.3 Antiarrhythmic Drugs -- References -- 5: Atrial Flutter and Fibrillation in the Emergency Setting -- 5.1 Focus on the Topic -- 5.2 What Physicians Working in ED Should Know -- 5.3 What Cardiologists Should Know -- 5.4 A Possible Algorithm/Pathway for Diagnosis and Treatment -- 5.4.1 Electrical Cardioversion -- 5.4.2 Drugs for Rhythm and Rate Control -- 5.4.2.1 Rhythm Control Drugs -- 5.4.2.2 Rate Control Drugs -- 5.5 Indications for Hospitalisation, Follow-Up and Referral -- References -- 6: Wide QRS Complex Tachycardia in the Emergency Setting -- 6.1 Wide QRS Complex Tachycardia -- 6.2 General Criteria -- 6.2.1 Atrioventricular Dissociation -- 6.2.2 Second-Degree V-A Block -- 6.2.3 Capture and Fusion Beats -- 6.2.4 Precordial QRS Concordance -- 6.2.5 Absence of RS Complexes in the Precordial Leads -- 6.2.6 Interval &gt -- 100 ms from QRS Complex Beginning to S Wave Nadir in a Precordial Lead -- 6.2.7 Vagal Stimulation Maneuvers -- 6.3 The Electrocardiogram in the Absence of Tachycardia -- 6.4 QRS Complex Morphology in Leads V1 and V6.
6.4.1 Wide QRS Complex Tachycardia with Right Bundle Branch Block-Type Configuration (Positive QRS Complex in Lead V1) -- 6.4.2 Wide QRS Complex Tachycardia with Left Bundle Branch Block-Type Morphology (Negative QRS Complex in Lead V1) -- 6.4.3 Limitations of Criteria Based on QRS Morphology in Wide QRS Complex Tachycardia -- 6.5 Other Signs -- 6.5.1 QRS Duration &gt -- 140 ms -- 6.5.2 QRS Axis Deviation -- 6.5.3 Regularity -- 6.6 Lead aVR Analysis -- 6.6.1 Step 1: Dominant Initial R Wave -- 6.6.2 Step 2: q or r initial Wave with Duration &gt -- 40 ms in qR or rS complexes -- 6.6.3 Step 3: Notch in the Descending Q Wave Limb of a Negative (QS or Qr) Ventricular Complex -- 6.6.4 Step 4: Vi/Vt Ratio -- 6.7 R Wave Peak Time at Lead II -- 6.8 Ventricular Versus Preexcited Tachycardia -- References -- 7: Acute Management of Arrhythmias in Patients with Known Congenital Heart Disease -- 7.1 Focusing on the Issue -- 7.2 What Physicians Working in ED Should Know -- 7.3 What Cardiologist Should Know -- 7.4 Indications for Hospitalization, Follow-Up, and Referral -- References -- 8: Acute Management of Arrhythmias in Patients with Channelopathies -- 8.1 Focusing on the Issue -- 8.2 Different Ways of Presentation -- 8.3 What Cardiologists Should Know -- 8.4 A Possible Algorithm/Pathway for Diagnosis and Treatment (Fig. 8.1 -- Table 8.1) -- 8.5 Indications for Hospitalization, Follow-Up, and Referral -- References -- 9: Acute Management of Patients with Arrhythmias and Non-cardiac Diseases: Metabolite Disorders and Ion Disturbances -- 9.1 Focusing on the Issue -- 9.1.1 Metabolite Disorders -- 9.1.1.1 Thyroid Disorders -- 9.1.1.2 Phaeochromocytoma -- 9.1.1.3 Acromegaly -- 9.1.1.4 Primary Aldosteronism, Addison Disease, Hyperparathyroidism and Hypoparathyroidism -- 9.1.1.5 Diabetic Ketoacidosis (DKA) -- 9.1.2 Ion Disturbances.
9.1.2.1 Potassium -- Hyperkalaemia -- Hypokalaemia -- Magnesium -- Calcium -- 9.1.2.2 Management of Arrhythmic Complications -- Treatment of Hyperkalaemia -- Treatment of Hypokalaemia -- Treatment of Hypermagnesaemia -- Treatment of Hypomagnesaemia -- Treatment of Hypercalcaemia -- Treatment of Hypocalcaemia -- 9.1.2.3 When Should Electrolyte Level Be Rechecked? -- 9.2 What Physicians Working in ED Should Know -- 9.3 What Cardiologists Should Know -- Bibliography -- 10: Cardiac Arrhythmias in Drug Abuse and Intoxication -- 10.1 Focusing on the Issue -- 10.2 What Physicians Working in Emergency Departments Should Know -- 10.3 What Physicians Working in the ED and Cardiologists Should Know -- 10.3.1 Recreational Drugs -- 10.3.1.1 Stimulants -- 10.3.1.2 Cocaine -- 10.3.1.3 Cannabinoids -- 10.3.2 Prescription Drugs -- 10.3.2.1 β-Blockers -- 10.3.2.2 Digitalis -- 10.3.2.3 Antiarrhythmic Drugs -- 10.3.2.4 Benzodiazepine -- 10.3.2.5 Antidepressant Agents -- 10.3.2.6 Antibiotics -- 10.4 A Suggested Algorithm/Pathway for Diagnosis and Treatment -- References -- 11: Pacemaker Malfunction: Myth or Reality? -- 11.1 Focusing on the Issue -- 11.2 What Physicians Working in Emergency Department Should Know -- 11.2.1 About Basic Function of Pacemakers and ECG Interpretation -- 11.2.2 Most Important, Basic Programmable Functions in a Pacemaker -- 11.3 What Cardiologists Should Know -- 11.3.1 Undersensing in Cardiac Pacemakers -- 11.3.1.1 Causes of Undersensing -- 11.3.1.2 Treatment of PM Undersensing -- 11.3.2 Undersensing in ICDs -- 11.3.3 Oversensing in Cardiac Pacemakers -- 11.3.3.1 Causes of Oversensing -- 11.3.3.2 Treatment of Oversensing -- 11.3.4 Oversensing in ICDs -- 11.3.5 Problems with Pacing -- 11.3.5.1 Causes of Failure to Capture -- 11.3.5.2 Treatment of Failure to Capture -- 11.4 False Malfunctions.
11.5 What to Do in Case a Pacemaker Malfunction Is Suspected -- References -- 12: Management of the Electrical Storm in Patients with ICD -- 12.1 Focusing on the Issue -- 12.2 What Physicians Working in ED and Anesthesiologists Should Know -- 12.2.1 How Is an ICD Made and How Does It Work? -- 12.2.2 How Does the ICD Recognize and Treat Arrhythmias (Appropriate Therapies)? -- 12.2.3 Inappropriate Therapies -- 12.2.4 Electrical Storm -- 12.2.4.1 Incidence and Clinical Predictors -- 12.2.4.2 Prognosis -- 12.3 What the Cardiologist Should Know -- 12.3.1 Antiarrhythmic Drugs -- 12.3.2 Device Reprogramming -- 12.3.2.1 Higher Heart Rate Threshold -- 12.3.2.2 Longer Detection Period -- 12.3.2.3 Improving ATP Programming -- 12.3.3 Sedation, General Anesthesia/Mechanical Ventilation, and Mechanical Hemodynamic Support -- 12.3.4 Neuraxial Modulation (Thoracic Epidural Anesthesia, Cardiac Sympathetic Denervation) -- 12.3.5 Catheter Ablation -- 12.4 Indication for Follow-Up and Referral -- References -- 13: Emergency Surgery and Cardiac Devices -- 13.1 Focusing on the Issue -- 13.2 What Physicians Working in ED, Anesthesiologists, and Surgeons Should Know -- 13.2.1 PM Programming Modes -- 13.2.2 Unipolar Versus Bipolar Leads -- 13.2.3 Unipolar Versus Bipolar Electrocautery -- 13.2.4 Effects of EMI on CIED: General Considerations -- 13.2.4.1 Reset -- 13.2.4.2 Generator Damages -- 13.2.4.3 Lead-Tissue Interface Damage -- 13.2.4.4 Oversensing -- 13.2.4.5 Pacemaker Response to EMI -- 13.2.4.6 ICD Response to EMI -- 13.2.5 Effects of the Magnet -- 13.2.5.1 Pacemakers -- 13.2.5.2 Implantable Defibrillators -- 13.2.6 How to Recognize that a Patient Has a CIED and if Is PM Dependent -- 13.2.7 How to Minimize the Risk -- 13.3 What the Cardiologist Should Know -- 13.3.1 Magnet Responses -- 13.3.2 Pacemakers -- 13.3.3 ICD.
13.4 A Suggested Algorithm/Pathway for Diagnosis and Treatment.
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Intro -- Foreword -- Preface -- Contents -- 1: Management of Arrhythmic Patients in the Emergency Department: General Principles -- 1.1 Triage -- 1.2 Emergency Department Physician Approach to the Arrhythmic Patient -- 1.2.1 Tachyarrhythmia -- 1.2.1.1 Procedural Sedation/Anesthesia During Cardioversion -- 1.2.1.2 Cardioversion/Defibrillation -- 1.2.1.3 When should the Cardiology Consultant be called? -- 1.2.1.4 Treatment of a Wide-QRS Complex Tachycardia -- 1.2.2 Bradycardia -- 1.2.3 Sinus Bradycardia -- 1.2.4 Pitfalls -- 1.2.5 Low-Rate Atrial Fibrillation -- 1.2.6 Sinus Node Dysfunction: Sick Sinus Syndrome -- 1.2.7 Atrioventricular (AV) Blocks -- 1.2.8 First-Degree AV Block -- 1.2.9 Second-Degree AV Block Type I (Wenckebach: Mobitz I) -- 1.2.10 Higher Degree AV Blocks (Second-Degree AV Block Type II and Third-Degree AV Block) -- 1.2.11 Second-Degree AV Block Type II (Mobitz II) -- 1.2.12 Third-Degree AV Block -- 1.2.13 Accelerated Idioventricular Rhythm -- 1.2.14 Treatment: -- 1.2.15 Pitfalls -- 1.2.16 When Should the Consultant Cardiologist Be Called? -- 1.2.17 Definitive Pacemaker Indications -- 1.2.18 A Suggested Algorithm/Pathway for Diagnosis and Treatment -- References -- 2: Syncope: First Evaluation and Management in the Emergency Department -- 2.1 Epidemiology of Syncope -- 2.2 Costs of Syncope -- 2.2.1 Difficulties in the Management of Patients with Syncope in the ED -- 2.2.2 The Recommended Management of Syncope in the ED -- References -- 3: Management of Bradyarrhythmias in Emergency -- 3.1 Anatomy and Pathophysiology -- 3.2 Bradycardia -- 3.3 Sinus Node Dysfunction -- 3.3.1 Sinus Bradycardia -- 3.3.2 Sinus Arrest -- 3.4 Atrioventricular Block -- 3.4.1 First-Degree AV Block -- 3.4.2 Second-Degree AV Block -- 3.4.3 Atrioventricular Block with 2:1 Conduction -- 3.4.4 Advanced AV Block.

3.4.5 Low-Rate Atrial Fibrillation -- 3.4.6 Third-Degree AV Block -- 3.4.7 Interventricular Block -- 3.4.8 Atrioventricular Dissociation -- 3.4.9 Conduction Disturbances during Acute Myocardial Infarction -- 3.4.10 Cardiac Arrest and Sudden Cardiac Death -- 3.5 Treatment -- 3.5.1 Temporary Pacemaker -- 3.5.2 Permanent Pacemaker -- Bibliography -- 4: Supraventricular Arrhythmias in Emergency -- 4.1 What Physicians Working in ED Should Know -- 4.1.1 Patients in Unstable Condition -- 4.1.2 Patients in Stable Condition -- 4.1.3 Management -- 4.1.3.1 Narrow QRS -- 4.1.3.2 Wide QRS -- 4.2 What Cardiologists Should Know -- 4.2.1 Basic Electrophysiologic Principles -- 4.2.2 Mechanisms of Arrhythmias -- 4.2.2.1 Focal -- 4.2.2.2 Reentry -- 4.2.3 Antiarrhythmic Drugs -- References -- 5: Atrial Flutter and Fibrillation in the Emergency Setting -- 5.1 Focus on the Topic -- 5.2 What Physicians Working in ED Should Know -- 5.3 What Cardiologists Should Know -- 5.4 A Possible Algorithm/Pathway for Diagnosis and Treatment -- 5.4.1 Electrical Cardioversion -- 5.4.2 Drugs for Rhythm and Rate Control -- 5.4.2.1 Rhythm Control Drugs -- 5.4.2.2 Rate Control Drugs -- 5.5 Indications for Hospitalisation, Follow-Up and Referral -- References -- 6: Wide QRS Complex Tachycardia in the Emergency Setting -- 6.1 Wide QRS Complex Tachycardia -- 6.2 General Criteria -- 6.2.1 Atrioventricular Dissociation -- 6.2.2 Second-Degree V-A Block -- 6.2.3 Capture and Fusion Beats -- 6.2.4 Precordial QRS Concordance -- 6.2.5 Absence of RS Complexes in the Precordial Leads -- 6.2.6 Interval &gt -- 100 ms from QRS Complex Beginning to S Wave Nadir in a Precordial Lead -- 6.2.7 Vagal Stimulation Maneuvers -- 6.3 The Electrocardiogram in the Absence of Tachycardia -- 6.4 QRS Complex Morphology in Leads V1 and V6.

6.4.1 Wide QRS Complex Tachycardia with Right Bundle Branch Block-Type Configuration (Positive QRS Complex in Lead V1) -- 6.4.2 Wide QRS Complex Tachycardia with Left Bundle Branch Block-Type Morphology (Negative QRS Complex in Lead V1) -- 6.4.3 Limitations of Criteria Based on QRS Morphology in Wide QRS Complex Tachycardia -- 6.5 Other Signs -- 6.5.1 QRS Duration &gt -- 140 ms -- 6.5.2 QRS Axis Deviation -- 6.5.3 Regularity -- 6.6 Lead aVR Analysis -- 6.6.1 Step 1: Dominant Initial R Wave -- 6.6.2 Step 2: q or r initial Wave with Duration &gt -- 40 ms in qR or rS complexes -- 6.6.3 Step 3: Notch in the Descending Q Wave Limb of a Negative (QS or Qr) Ventricular Complex -- 6.6.4 Step 4: Vi/Vt Ratio -- 6.7 R Wave Peak Time at Lead II -- 6.8 Ventricular Versus Preexcited Tachycardia -- References -- 7: Acute Management of Arrhythmias in Patients with Known Congenital Heart Disease -- 7.1 Focusing on the Issue -- 7.2 What Physicians Working in ED Should Know -- 7.3 What Cardiologist Should Know -- 7.4 Indications for Hospitalization, Follow-Up, and Referral -- References -- 8: Acute Management of Arrhythmias in Patients with Channelopathies -- 8.1 Focusing on the Issue -- 8.2 Different Ways of Presentation -- 8.3 What Cardiologists Should Know -- 8.4 A Possible Algorithm/Pathway for Diagnosis and Treatment (Fig. 8.1 -- Table 8.1) -- 8.5 Indications for Hospitalization, Follow-Up, and Referral -- References -- 9: Acute Management of Patients with Arrhythmias and Non-cardiac Diseases: Metabolite Disorders and Ion Disturbances -- 9.1 Focusing on the Issue -- 9.1.1 Metabolite Disorders -- 9.1.1.1 Thyroid Disorders -- 9.1.1.2 Phaeochromocytoma -- 9.1.1.3 Acromegaly -- 9.1.1.4 Primary Aldosteronism, Addison Disease, Hyperparathyroidism and Hypoparathyroidism -- 9.1.1.5 Diabetic Ketoacidosis (DKA) -- 9.1.2 Ion Disturbances.

9.1.2.1 Potassium -- Hyperkalaemia -- Hypokalaemia -- Magnesium -- Calcium -- 9.1.2.2 Management of Arrhythmic Complications -- Treatment of Hyperkalaemia -- Treatment of Hypokalaemia -- Treatment of Hypermagnesaemia -- Treatment of Hypomagnesaemia -- Treatment of Hypercalcaemia -- Treatment of Hypocalcaemia -- 9.1.2.3 When Should Electrolyte Level Be Rechecked? -- 9.2 What Physicians Working in ED Should Know -- 9.3 What Cardiologists Should Know -- Bibliography -- 10: Cardiac Arrhythmias in Drug Abuse and Intoxication -- 10.1 Focusing on the Issue -- 10.2 What Physicians Working in Emergency Departments Should Know -- 10.3 What Physicians Working in the ED and Cardiologists Should Know -- 10.3.1 Recreational Drugs -- 10.3.1.1 Stimulants -- 10.3.1.2 Cocaine -- 10.3.1.3 Cannabinoids -- 10.3.2 Prescription Drugs -- 10.3.2.1 β-Blockers -- 10.3.2.2 Digitalis -- 10.3.2.3 Antiarrhythmic Drugs -- 10.3.2.4 Benzodiazepine -- 10.3.2.5 Antidepressant Agents -- 10.3.2.6 Antibiotics -- 10.4 A Suggested Algorithm/Pathway for Diagnosis and Treatment -- References -- 11: Pacemaker Malfunction: Myth or Reality? -- 11.1 Focusing on the Issue -- 11.2 What Physicians Working in Emergency Department Should Know -- 11.2.1 About Basic Function of Pacemakers and ECG Interpretation -- 11.2.2 Most Important, Basic Programmable Functions in a Pacemaker -- 11.3 What Cardiologists Should Know -- 11.3.1 Undersensing in Cardiac Pacemakers -- 11.3.1.1 Causes of Undersensing -- 11.3.1.2 Treatment of PM Undersensing -- 11.3.2 Undersensing in ICDs -- 11.3.3 Oversensing in Cardiac Pacemakers -- 11.3.3.1 Causes of Oversensing -- 11.3.3.2 Treatment of Oversensing -- 11.3.4 Oversensing in ICDs -- 11.3.5 Problems with Pacing -- 11.3.5.1 Causes of Failure to Capture -- 11.3.5.2 Treatment of Failure to Capture -- 11.4 False Malfunctions.

11.5 What to Do in Case a Pacemaker Malfunction Is Suspected -- References -- 12: Management of the Electrical Storm in Patients with ICD -- 12.1 Focusing on the Issue -- 12.2 What Physicians Working in ED and Anesthesiologists Should Know -- 12.2.1 How Is an ICD Made and How Does It Work? -- 12.2.2 How Does the ICD Recognize and Treat Arrhythmias (Appropriate Therapies)? -- 12.2.3 Inappropriate Therapies -- 12.2.4 Electrical Storm -- 12.2.4.1 Incidence and Clinical Predictors -- 12.2.4.2 Prognosis -- 12.3 What the Cardiologist Should Know -- 12.3.1 Antiarrhythmic Drugs -- 12.3.2 Device Reprogramming -- 12.3.2.1 Higher Heart Rate Threshold -- 12.3.2.2 Longer Detection Period -- 12.3.2.3 Improving ATP Programming -- 12.3.3 Sedation, General Anesthesia/Mechanical Ventilation, and Mechanical Hemodynamic Support -- 12.3.4 Neuraxial Modulation (Thoracic Epidural Anesthesia, Cardiac Sympathetic Denervation) -- 12.3.5 Catheter Ablation -- 12.4 Indication for Follow-Up and Referral -- References -- 13: Emergency Surgery and Cardiac Devices -- 13.1 Focusing on the Issue -- 13.2 What Physicians Working in ED, Anesthesiologists, and Surgeons Should Know -- 13.2.1 PM Programming Modes -- 13.2.2 Unipolar Versus Bipolar Leads -- 13.2.3 Unipolar Versus Bipolar Electrocautery -- 13.2.4 Effects of EMI on CIED: General Considerations -- 13.2.4.1 Reset -- 13.2.4.2 Generator Damages -- 13.2.4.3 Lead-Tissue Interface Damage -- 13.2.4.4 Oversensing -- 13.2.4.5 Pacemaker Response to EMI -- 13.2.4.6 ICD Response to EMI -- 13.2.5 Effects of the Magnet -- 13.2.5.1 Pacemakers -- 13.2.5.2 Implantable Defibrillators -- 13.2.6 How to Recognize that a Patient Has a CIED and if Is PM Dependent -- 13.2.7 How to Minimize the Risk -- 13.3 What the Cardiologist Should Know -- 13.3.1 Magnet Responses -- 13.3.2 Pacemakers -- 13.3.3 ICD.

13.4 A Suggested Algorithm/Pathway for Diagnosis and Treatment.

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