Irregular heart rhythms

Overview

 * Patients with a conscious, unpleasant awareness of their heartbeat.

Differential Diagnosis
In alphabetical order.


 * Atrial fibrillation
 * Atrial flutter with variable block
 * Bradyarrhythmias
 * Extrasystoles
 * Multifocal atrial tachycardia
 * Paroxysmal atrial tachycardia
 * Premature atrial contractions
 * Premature ventricular contractions
 * Sinus arrhythmia
 * Wandering atrial pacemaker

History and Symptoms

 * Palpitations
 * Dyspnea
 * Chest pain
 * Syncope
 * Lightheadedness

Laboratory Findings

 * Complete blood count (CBC)
 * Calcium
 * Pulse oximetry
 * Arterial blood gases (ABG)
 * Blood urea nitrogen (BUN) / creatinine
 * Cardiac enzymes
 * Toxicology screen
 * Thyroid stimulating hormone (TSH)

Electrolyte and Biomarker Studies

 * Electrolytes

Electrocardiogram

 * ECG with rhythm strip

Chest X Ray

 * Chest X-ray

Echocardiography or Ultrasound

 * Echocardiogram may be necessary
 * Transesophageal echocardiography more sensitive than transthoracic echocardiography

Treatment

 * Administration of supplemental oxygen
 * Hemodynamic stability
 * Cardioversion
 * Radiofrequency ablation

Acute Pharmacotherapies

 * Adenosine
 * Anti-arrhythmic medications
 * Beta-blockers
 * Calcium channel blockers
 * Coumadin
 * Digoxin