Does my patient need an electrophysiological study?
| ||The decision to refer a patient for an electrophysiological study is based upon the type of conduction abnormality present. |
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HPI: Episode of sudden cardiac arrest, palpitations, dyspnea, syncope, fatigue, lightheadedness.
PMH: Cardiac arrest, atrioventricular block, atrial fibrillation, atrial flutter, ventricular tachycardia.
| ||P waves absent, biphasic "sawtooth" flutter waves present, narrow QRS complex, prolonged PR interval of fixed duration followed by a P wave that fails to conduct to the ventricles, dissociation between P wave and QRS. |
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EP = Refer patient for ElectroPhysiological study.
RS = Patient with Recurrent Syncope that remains unexplained after an appropriate evaluation.
SND = Patient with Sinus Node Dysfunction.
S-AVB = Symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients in whom AtrioVentricular Block is suspected.
IVCD = IntraVentricular Conduction Delay in symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients.
NCT = Narrow Complex Tachycardia.
WCT = Wide Complex Tachycardia.
SRCA = SuRvivor of Cardiac Arrest without obvious reversible cause.
C-ABL = Patients with symptomatic supraventricular tachycardia due to AVNRT, symptomatic atrial tachyarrhythmias, or ventricular tachycardia amenable to Catheter ABLation.
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RS = EP
SND = EP
S-AVB = EP
IVCD = EP
NCT = EP
WCT = EP
SRCA = EP
C-ABL = EP
| ||Electrophysiological studies provide valuable diagnostic information as they can determine the mechanisms of arrhythmia and help in the decision of whether drug, device, or ablation therapy is suitable. |
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Tracy CM, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion. Circulation. 2000;102:2309.
When do I need to order a stress test?
| ||Stress testing is used in diagnosis and prognosis of coronary artery disease. It is done via exercise (treadmill, bicycle) or pharmacologic agents (adenosine, persantine, dobutamine). |
| ||Patients with symptoms of known/probable ischemic heart disease, stable angina controlled by medicine. The most important clinical finding is chest pain. |
| ||Determine if the patient has functional capacity to perform exercise or will need pharmacologic aid to achieve stress. |
| ||J point depression of 0.1 mV or more and/or ST segment slope of 1 mV/s in 3 consecutive beats (during stress). |
| ||Echocardiogram-check LVEF, wall motion abnormalities, hypertrophy. |
CAD = Coronary Artery Disease. Patients with intermediate pretest probability of CAD based on age, sex, and symptoms.
RA = Risk Assessment and prognosis of symptomatic patients of those with CAD. Initial evaluation for CAD, changes in clinical status, unstable angina free of symptoms.
POST-MI = Testing after Myocardial Infarction. Prognostic assessment ...
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