Atrial fibrillation other imaging findings: Difference between revisions
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| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]] | |||
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]] | |||
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{{Template:Atrial fibrillation}} | {{Template:Atrial fibrillation}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Anahita}} | ||
==Ambulatory Holter | ==Overview== | ||
Two other [[diagnosis|diagnostic studies]] include the [[Holter monitor]] to assess [[symptom|symptomatic]] episodes of [[atrial fibrillation]] over a 24 hour period and [[exercise stress testing]] to assess how [[patients]]' [[heart rate]] responds to [[exertion]]. The main benefits to performing an [[exercise stress test]] are to reproduce [[exertion|exercise]] induced [[atrial fibrillation]], and to exclude [[ischemia]] before initiating [[treatment]] with type 1C [[antiarrhythmic]] [[medications]]. | |||
==Other Imaging Studies== | |||
===Ambulatory Holter Monitoring=== | |||
{{main|Holter monitor}} | {{main|Holter monitor}} | ||
A [[ | *A [[Holter monitor]] is a wearable ambulatory [[heart]] monitor that continuously monitors the [[heart rate]] and [[Sinus rhythm|heart rhythm]] for a short duration, typically 24 hours. <ref name="pmid16627441">{{cite journal| author=Vincenti A, Brambilla R, Fumagalli MG, Merola R, Pedretti S| title=Onset mechanism of paroxysmal atrial fibrillation detected by ambulatory Holter monitoring. | journal=Europace | year= 2006 | volume= 8 | issue= 3 | pages= 204-10 | pmid=16627441 | doi=10.1093/europace/euj043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16627441 }} </ref> | ||
*In individuals with [[symptoms]] of significant [[shortness of breath]] with [[exertion]] or [[palpitations]] on a regular basis, a [[Holter monitor]] may be of benefit to determine if [[Tachycardia|rapid heart rate]]s (or unusually [[bradycardia|slow heart rate]]s) during [[atrial fibrillation]] is the cause of the [[symptoms]].<ref name="pmid16627441">{{cite journal| author=Vincenti A, Brambilla R, Fumagalli MG, Merola R, Pedretti S| title=Onset mechanism of paroxysmal atrial fibrillation detected by ambulatory Holter monitoring. | journal=Europace | year= 2006 | volume= 8 | issue= 3 | pages= 204-10 | pmid=16627441 | doi=10.1093/europace/euj043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16627441 }} </ref> | |||
*Based on some experimental studies, longer duration of [[Holter monitoring]] (7 days) could be beneficial for [[patients]] with [[symptoms]] of cerebral ischemic events.<ref name="pmid20966415">{{cite journal| author=Stahrenberg R, Weber-Krüger M, Seegers J, Edelmann F, Lahno R, Haase B | display-authors=etal| title=Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm. | journal=Stroke | year= 2010 | volume= 41 | issue= 12 | pages= 2884-8 | pmid=20966415 | doi=10.1161/STROKEAHA.110.591958 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20966415 }} </ref><ref name="pmid18990460">{{cite journal| author=Dagres N, Kottkamp H, Piorkowski C, Weis S, Arya A, Sommer P | display-authors=etal| title=:Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. | journal=Int J Cardiol | year= 2010 | volume= 139 | issue= 3 | pages= 305-6 | pmid=18990460 | doi=10.1016/j.ijcard.2008.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18990460 }} </ref> | |||
==Exercise | ===Exercise Stress Testing=== | ||
{{main|Cardiac stress test}} | {{main|Cardiac stress test}} | ||
Some individuals with atrial fibrillation do well with normal activity but develop shortness of breath with exertion. It may be unclear if the shortness of breath is due to a blunted heart rate response to exertion due to excessive AV node blocking agents, a very rapid heart rate during exertion, or due to other underlying conditions such as chronic lung disease or coronary ischemia. An [[cardiac stress test|exercise stress test]] will evaluate the individual's heart rate response to exertion and determine if the AV node blocking agents are contributing to the symptoms. As a summary the main benefits of performing an exercise stress testing | *Some individuals with [[atrial fibrillation]] do well with normal activity but develop [[dyspnea|shortness of breath with [[exertion]].It may be unclear if the [[dyspnea|shortness of breath]] is due to a blunted [[heart rate]] response to [[exertion]] due to excessive [[Antiarrhythmic agent|AV node blocking agents]], a very [[rapid heart rate]] during [[exertion]], or due to other underlying conditions such as [[Chronic (medical)|chronic]] [[Respiratory disease|lung disease]] or [[ischemia|coronary ischemia]].<ref name="pmid20953841">{{cite journal| author=Nucifora G, Schuijf JD, van Werkhoven JM, Trines SA, Kajander S, Tops LF | display-authors=etal| title=Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. | journal=Int J Cardiovasc Imaging | year= 2011 | volume= 27 | issue= 6 | pages= 777-85 | pmid=20953841 | doi=10.1007/s10554-010-9725-x | pmc=3144360 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20953841 }} </ref><ref name="pmid4590953">{{cite journal| author=Jelinek MV, Lown B| title=Exercise stress testing for exposure of cardiac arrhythmia. | journal=Prog Cardiovasc Dis | year= 1974 | volume= 16 | issue= 5 | pages= 497-522 | pmid=4590953 | doi=10.1016/0033-0620(74)90008-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4590953 }} </ref> | ||
*An [[cardiac stress test|exercise stress test]] will evaluate the individual's [[heart rate]] response to [[exertion]] and determine if the [[Antiarrhythmic agent|AV node blocking agents]] are contributing to the [[symptoms]].<ref name="pmid4590953">{{cite journal| author=Jelinek MV, Lown B| title=Exercise stress testing for exposure of cardiac arrhythmia. | journal=Prog Cardiovasc Dis | year= 1974 | volume= 16 | issue= 5 | pages= 497-522 | pmid=4590953 | doi=10.1016/0033-0620(74)90008-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4590953 }} </ref> | |||
*If the adequacy of rate control is in question (permanent | *As a summary the main benefits of performing an [[exercise stress testing]] are:<ref name="pmid20953841">{{cite journal| author=Nucifora G, Schuijf JD, van Werkhoven JM, Trines SA, Kajander S, Tops LF | display-authors=etal| title=Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. | journal=Int J Cardiovasc Imaging | year= 2011 | volume= 27 | issue= 6 | pages= 777-85 | pmid=20953841 | doi=10.1007/s10554-010-9725-x | pmc=3144360 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20953841 }} </ref> | ||
*To reproduce exercise | **If the adequacy of [[heart rate|rate]] control is in question ([[atrial fibrillation|permanent atrial fibrillation]]) | ||
*To exclude ischemia before treatment of selected patients with a type IC antiarrhythmic drug | **To reproduce [[Physical exercise|exercise]] induced [[atrial fibrillation]] ([[AF]]) | ||
**To exclude [[ischemia]] before [[treatment]] of selected [[patients]] with a type IC [[antiarrhythmic]] [[drug]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[CME Category::Cardiology]] | |||
[[Category:Cardiology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Arrhythmia]] | |||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
[[Category: | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 04:46, 25 October 2021
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Sinus rhythm  |
Atrial fibrillation  |
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Atrial Fibrillation Microchapters | |
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Diagnosis | |
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Atrial fibrillation other imaging findings On the Web | |
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Directions to Hospitals Treating Atrial fibrillation other imaging findings | |
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Risk calculators and risk factors for Atrial fibrillation other imaging findings | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Two other diagnostic studies include the Holter monitor to assess symptomatic episodes of atrial fibrillation over a 24 hour period and exercise stress testing to assess how patients' heart rate responds to exertion. The main benefits to performing an exercise stress test are to reproduce exercise induced atrial fibrillation, and to exclude ischemia before initiating treatment with type 1C antiarrhythmic medications.
Other Imaging Studies
Ambulatory Holter Monitoring
- A Holter monitor is a wearable ambulatory heart monitor that continuously monitors the heart rate and heart rhythm for a short duration, typically 24 hours. [1]
- In individuals with symptoms of significant shortness of breath with exertion or palpitations on a regular basis, a Holter monitor may be of benefit to determine if rapid heart rates (or unusually slow heart rates) during atrial fibrillation is the cause of the symptoms.[1]
- Based on some experimental studies, longer duration of Holter monitoring (7 days) could be beneficial for patients with symptoms of cerebral ischemic events.[2][3]
Exercise Stress Testing
- Some individuals with atrial fibrillation do well with normal activity but develop [[dyspnea|shortness of breath with exertion.It may be unclear if the shortness of breath is due to a blunted heart rate response to exertion due to excessive AV node blocking agents, a very rapid heart rate during exertion, or due to other underlying conditions such as chronic lung disease or coronary ischemia.[4][5]
- An exercise stress test will evaluate the individual's heart rate response to exertion and determine if the AV node blocking agents are contributing to the symptoms.[5]
- As a summary the main benefits of performing an exercise stress testing are:[4]
- If the adequacy of rate control is in question (permanent atrial fibrillation)
- To reproduce exercise induced atrial fibrillation (AF)
- To exclude ischemia before treatment of selected patients with a type IC antiarrhythmic drug
References
- ↑ 1.0 1.1 Vincenti A, Brambilla R, Fumagalli MG, Merola R, Pedretti S (2006). "Onset mechanism of paroxysmal atrial fibrillation detected by ambulatory Holter monitoring". Europace. 8 (3): 204–10. doi:10.1093/europace/euj043. PMID 16627441.
- ↑ Stahrenberg R, Weber-Krüger M, Seegers J, Edelmann F, Lahno R, Haase B; et al. (2010). "Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm". Stroke. 41 (12): 2884–8. doi:10.1161/STROKEAHA.110.591958. PMID 20966415.
- ↑ Dagres N, Kottkamp H, Piorkowski C, Weis S, Arya A, Sommer P; et al. (2010). ":Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up". Int J Cardiol. 139 (3): 305–6. doi:10.1016/j.ijcard.2008.10.004. PMID 18990460.
- ↑ 4.0 4.1 Nucifora G, Schuijf JD, van Werkhoven JM, Trines SA, Kajander S, Tops LF; et al. (2011). "Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation". Int J Cardiovasc Imaging. 27 (6): 777–85. doi:10.1007/s10554-010-9725-x. PMC 3144360. PMID 20953841.
- ↑ 5.0 5.1 Jelinek MV, Lown B (1974). "Exercise stress testing for exposure of cardiac arrhythmia". Prog Cardiovasc Dis. 16 (5): 497–522. doi:10.1016/0033-0620(74)90008-5. PMID 4590953.