Palpitations and Syncope

Question 1

what is the test in a pt w/ palpitations and syncope?

Answer 1

ECG during the event

Question 2

how do you determine the most appropriate test to order in a pt w/ palpitations and syncope?

Answer 2

frequency and duration of sxs

Question 3

when should an echocardiogram be ordered in a pt w/ palpitations and syncope?

Answer 3

if structural heart disease is suspected

Question 4

diagnostic studies for suspected arrhythmias:

• initial diagnostic test in ALL pts

Answer 4

resting ECG

Question 5

diagnostic studies for suspected arrhythmias:

• indicated for frequent (at least daily) arrythmias

Answer 5

ambulatory (24-hour) ECG

Question 6

diagnostic studies for suspected arrhythmias:

• indicated for arrhythmias provoked by exercise

Answer 6

exercise ECG

Question 7

diagnostic studies for suspected arrhythmias:

• indicated for infrequent arrhythmias > 1-2 minutes in duration

Answer 7

event monitor

Question 8

diagnostic studies for suspected arrhythmias:

• indicated for infrequent symptomatic brief arrhythmias

Answer 8

loop recorder

Question 9

diagnostic studies for suspected arrhythmias:

• indicated for very infrequent arrhythmias

Answer 9

implanted recorder

Question 10

diagnostic studies for suspected arrhythmias:

• indicated for treatment (eg catheter ablation), NOT for diagnosis

Answer 10

electrophysiology study

Question 11

diagnostic studies for suspected arrhythmias:

• advantage of resting ECG

Answer 11

diagnostic IF recorded during arrhythmia

Question 12

diagnostic studies for suspected arrhythmias:

• disadvantage of resting ECG

Answer 12

arrhythmias usually not caught on resting ECG

Question 13

diagnostic studies for suspected arrhythmias:

• advantage of ambulatory (24-hour) ECG

Answer 13

records everything for 24 hours

Question 14

diagnostic studies for suspected arrhythmias:

• disadvantage of ambulatory (24-hour) ECG

Answer 14

not helpful if arrhythmia isn’t caught

Question 15

diagnostic studies for suspected arrhythmias:

• advantage of exercise ECG

Answer 15

allows dx if arrhythmia really is exercise-related

Question 16

diagnostic studies for suspected arrhythmias:

• disadvantage of exercise ECG

Answer 16

physician supervision required

Question 17

diagnostic studies for suspected arrhythmias:

• disadvantages of event monitor

Answer 17

• has to be symptomatic arrhythmia and pt has to activate device in time
• can’t use on pts w/ syncope

Question 18

diagnostic studies for suspected arrhythmias:

• advantages of loop recorder

Answer 18

• saves 30 seconds to 2 minutes when activated by pt

- can be activated after syncopal event

Question 19

diagnostic studies for suspected arrhythmias:

• disadvantage of loop recorder

Answer 19

limits pt activities

Question 20

diagnostic studies for suspected arrhythmias:

• advantage of implanted recorder

Answer 20

long-term continuous ECG monitoring

Question 21

diagnostic studies for suspected arrhythmias:

• disadvantage of implanted recorder

Answer 21

invasive procedure

Question 22

diagnostic studies for suspected arrhythmias:

• advantage of electrophysiology study

Answer 22

origin and mechanism of arrhythmia can be figured out

Question 23

diagnostic studies for suspected arrhythmias:

• disadvantage of electrophysiology study

Answer 23

invasive procedure