Arrhythmia

Palpitations: careful assessment reduces the time to diagnosis

Palpitations are a common presentation in general practice and a frequent reason for cardiology referrals. They generally cause considerable distress and anxiety to the patient and can also evoke feelings of uncertainty in the health professional consulted, but the good news is that palpitations are often benign. The skill lies in identifying patients with a significant heart rhythm abnormality that could be helped by treatment and those at risk of adverse outcome. This can be achieved by taking a careful history and simple investigations.

Aspirin or Warfarin for Atrial Fibrillation

Warfarin for atrial fibrillation: ‘faff’ or lifesaver?

Improving the management and prevention of stroke is a priority for the NHS. Atrial fibrillation (AF) is widely recognised to be a major cause of stroke. Moreover, it is a preventable cause in that the increased risk of stroke associated with AF can be markedly reduced by anticoagulation with warfarin. Yet a substantial number of cases of AF remain undetected and untreated. Of more concern, even after identification of AF, many individuals at high risk of stroke do not receive warfarin. This article reviews the evidence on the importance of AF as a cause of stroke and assesses the benefits of anticoagulation and our reluctance to anticoagulate. Finally, it explores ways of improving on current practice, to increase the proportion of patients with AF receiving anticoagulants.

Optimising Management of Supraventricular Arrhythmias

Caring for patients with arrhythmias has evolved over the past decade as a result of technological innovation in both diagnosis and treatment. This article highlights some of the most common arrhythmias and reviews the most appropriate strategies for their medical management. The National Service Framework (NSF) for Coronary Heart Disease (CHD) sets out three quality standards in the chapter on arrhythmias and sudden cardiac death and we look at how to successfully implement these.

Atrial fibrillation: giving your patients the best care

Atrial fibrillation (AF) is a condition that we are seeing more and more in general practice, with the increasingly ageing population. It is an important risk factor for stroke – particularly in older people – making it a good candidate for primary care teams to target in efforts to prevent cardiovascular disease. In this article, we explore how to diagnose and treat, using a case study to guide us through the key issues.

How to Get Top Marks for Identifying and Managing Atrial Fibrillation

Beating Arrhythmias

Arrhythmias are extremely common. They are usually benign but their significance depends on the symptoms they cause. Some arrhythmias are more serious and can be life-threatening. In this article we clarify the causes of arrhythmias and help you sort out the different types that can occur, dividing them into the two main categories – tachyarrhythmias, where the heart rate is faster than normal, and bradyarrhythmias, where the heart rate is much slower than normal.

Heart Murmurs – When Are They Significant?

Heart murmurs – abnormal sounds heard through the stethoscope – are caused by turbulent blood flow in the heart or blood vessels. They can be associated with a range of conditions, including valve defects, high blood pressure and heart failure in adults and congenital heart defects in children. Patients should be investigated carefully to identify the underlying cause, which will determine treatment and prognosis. Some pathological murmurs require no treatment. If they are severe, however, surgery may be needed to correct the causative defect. Drug treatments may be indicated for some murmurs.

Implantable Cardioverter Defibrillators (ICDs)

Implantable Cardioverter Defibrillators (ICDs) have – quite literally – fired a major revolution in the management of patients at high risk for potentially life-threatening arrhythmias. More sophisticated than pacemakers, ICDs monitor the heart constantly, but only initiate an electrical signal when they detect an incorrect heart rhythm. ICDs can function as pacemakers for slow heart rates, but may also deliver high-energy electrical therapy for fast heart rates. In this article, we review how ICDs work, how they are used and what care we need to provide for patients who have had these devices implanted.

Atrial Fibrillation

Atrial fibrillation (AF) is one of those terms that we are hearing more and more in general practice. It is an important risk factor for stroke – particularly in older people – making it a good candidate for primary care teams to target in efforts to prevent cardiovascular disease.

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