Paroxysmal AV block Initial Approach: Difference between revisions
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==Overview== | ==Overview== | ||
An initial evaluation strategy of taking '''a detailed history, physical examination, risk stratification, ECG recording and BP measurement''' should help decide what investigations should be ordered (based on whether the syncope is cardiac related, reflex/neutrally mediated, secondary to cerebrovascular disease or due to orthostatic hypotension). | An initial [[evaluation]] strategy of taking '''a detailed [[history]], [[physical examination]], risk stratification, [[ECG]] recording and [[BP]] measurement''' should help decide what investigations should be ordered (based on whether the [[syncope]] is [[cardiac]] related, [[reflex]]/[[neutrally]] mediated, secondary to [[cerebrovascular disease]] or due to [[orthostatic hypotension]]). | ||
==Initial Approach== | ==Initial Approach== | ||
*The pathway to conclusively diagnosing a patient with paroxysmal AV block is not straightforward. | *The pathway to conclusively diagnosing a patient with [[paroxysmal AV block]] is not straightforward. | ||
*Since most patients present with a history of recurrent unexplained syncope and fortuitous timing would be required to document classical ECG findings during an acute episode, it would be best to treat it as a '''diagnosis of exclusion'''. | *Since most patients present with a history of recurrent unexplained [[syncope]] and fortuitous timing would be required to document classical ECG findings during an acute episode, it would be best to treat it as a '''diagnosis of exclusion'''. | ||
*An initial evaluation strategy of taking '''a detailed history, physical examination, risk stratification, ECG recording and BP measurement''' should help decide what investigations should be ordered (based on whether the syncope is cardiac related, reflex/neutrally mediated, secondary to cerebrovascular disease or due to orthostatic hypotension). {{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}} | *An initial evaluation strategy of taking '''a [[detailed history]], [[physical examination]], [[Risk stratification tools|risk]] stratification, [[ECG]] recording and [[BP]] measurement''' should help decide what investigations should be ordered (based on whether the [[syncope]] is [[cardiac]] related, [[reflex]]/neutrally mediated, secondary to [[cerebrovascular disease]] or due to [[orthostatic hypotension]]). {{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}} | ||
[[Image:Initial_Strategy_Syncope or Paroxysmal AV Block.JPG|thumb|center|500px| Initial approach - {{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}}]] | [[Image:Initial_Strategy_Syncope or Paroxysmal AV Block.JPG|thumb|center|500px| Initial approach - {{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}}]] | ||
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=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Approach to AV Block= | =2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Approach to AV Block= | ||
[[Image: Initial Approach AHA.JPG|thumb|center|500px| Initial Approach to AV Block - <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on | [[Image: Initial Approach AHA.JPG|thumb|center|500px| Initial Approach to AV Block - <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710 }} </ref>]] | ||
==References== | ==References== | ||
Latest revision as of 12:25, 2 July 2020
Overview
An initial evaluation strategy of taking a detailed history, physical examination, risk stratification, ECG recording and BP measurement should help decide what investigations should be ordered (based on whether the syncope is cardiac related, reflex/neutrally mediated, secondary to cerebrovascular disease or due to orthostatic hypotension).
Initial Approach
- The pathway to conclusively diagnosing a patient with paroxysmal AV block is not straightforward.
- Since most patients present with a history of recurrent unexplained syncope and fortuitous timing would be required to document classical ECG findings during an acute episode, it would be best to treat it as a diagnosis of exclusion.
- An initial evaluation strategy of taking a detailed history, physical examination, risk stratification, ECG recording and BP measurement should help decide what investigations should be ordered (based on whether the syncope is cardiac related, reflex/neutrally mediated, secondary to cerebrovascular disease or due to orthostatic hypotension). "ESC Guidelines on Syncope (Diagnosis and Management of)".
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Approach to AV Block
References
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society". J Am Coll Cardiol. 74 (7): 932–987. doi:10.1016/j.jacc.2018.10.043. PMID 30412710.