Published: 10/06/2014. Arrhythmia Pathway

Transcription

1 Ahythmia Pathway

2 Pa%ent pesents with symptoms, palpita%ons, chest pain, dyspnoea, syncope/pe syncope, asymptoma%c Suspected Ahythmia Pathway Diagnosis Management Page 1 of 4 Review of esults to detemine if single episode. Nomal ECG and no evidence of stuctual heat disease. Conside othe diagnosis and futhe inves%ga%on if appopiate. Management in pimay cae. Conside vitual Cadiac advice Sevice Nomal esults changes equied e.g. educe caffeine intake Assessment: histoy & examina%on. Onset of symptoms (dua%on) palpita%ons, dyspnoea, and impact of ac%vi%es of daily living o at night. Past medical histoy & family histoy. Examina%on: Geneal appeaance, espiatoy ate, pulse, BP, chest ausculta%on. Full blood count, uea & electolytes, glucose, TFTs & LFTs and chest X ay if appopiate 12 lead ECG with accuate intepeta%on and epo%ng. Conside echocadiogam Abnomal esults with ecuent symptoms LIFESTYLE Impact of execise and advise egading management to maintain an ac%ve lifestyle without fea Smoking cessa%on couse Alchohol advice and guidance on healthy ea%ng * In all adult age goups, use taffic lights system to guide futhe acon (pages 2&3) Atial fibilla%on Complete CHADS₂ - Vasc isk scoe Recuent palpita%ons, ecuent pe-syncope/ syncope/symptoma%c Wok diving o flying issues. Sensi%ve issues egading sexual ac%vity. Ugent o immediate efeal to badycadia Seconday Cae, depending on clinical pictue Pa%ent looks unwell e.g. signs of heat failue Execise induced dizziness/syncope Syncope with injuy Syncope with angina Syncope with known stuctual/ ischaemic heat disease Incidental finding of Atial fibilla%on e.g. pulse check Community Ahythmia clinic Consultant led with Ahythmia Nuse Specialist Refeal to Community Ahythmia clinic if: Age <65ys Adequate heat ate o hythm contol not achieved 2nd o 3d Degee Heat Block Symptoma%c despite good ate/hythm contol Othe ECG abnomality evidence of pevious MI, LV hypetophy, shot PR inteval, long QT, LBBB, significant t-wave invesion Dischage to pimay cae as appopiate Family histoy of inheited cadiac Paoxysmal AF AF with othe ECG abnomality, stuctual heat disease o heat failue condi%on (See page 4 of pathway) Lone AF e.g. no histoy of echo evidence of cadiovascula disease Ini%ate An%coagulant theapy if appopiate with Key: = Wok up in Pimay Cae Inheited Cadiac Pimay Cae management with annual eview to monito ate and hythm in line with Coydon guidelines. = Caied out in Community Clinic = Refe onto Seconday Cae Immediate tansfe to hospital fo specialist Condi%on Clinic hbp://nhscoydonintanet.coydonpct.nhs.uk/ TeamsAndDepatments/pimaycaecommissioning/ pescibing/pages/documents.aspx = Refeal Pocess assessment/teatment = Steps that ae based in acute = Decision making point Please be awae that fo any clinical ques%ons thee is a consultant led advice sevice available to GPs in Coydon. Infoma%on can be found at the link below: hbp:// Community An% Coagulant Clinic

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5 Suspected Ahythmia Pathway Diagnosis Management Page 4 of 4 Inheited Cadiovascula Condition Clinic RED FLAG SYMPTOMS Childen and adults <45ys pesent with : Seconday Cae Local DGH Syncope: - exetional - unexplained - non-vasovagal Exetional chest pain Palpitation with lightheadedness Suspectedcase o family histoy of inheited disease (not disease due to poo lifestyle choices): Cadiomyopathies including - Hypetophic - Dilated - Ahythmogenic Channelopathies including - LQTS - Bugada syndome Mafan's o othe Aotopathies Family histoy of unexplained sudden death (SADS) o pematue SCD (<45) P i m a y C a e FAST TRACK to one stop clinic: Chest pain clinic Syncope clinic Ahythmia clinic A and E In-patient admissions: cadiac aest, syncope, VT and heat failue Incidental o othe findings: Patients efeed fo othe eason DIRECT REFERRAL TO ICC CLINIC Evidence/suspicion of inheited heat disease - liaise with inheited cadiac disease clinic (ICC) fo suppot and advice including Multidisciplinay Team meeting. DIRECT REFERRAL (out-patient and in-patient) Inheited Cadiovascula Condition (ICC) Clinic within Health Innovation Netwok Positive diagnosis: If high isk follow-up in ICC clinic. If low isk efe back to seconday o pimay cae with management plan Equivocal diagnosis: Follow-up in ICC. Negative diagnosis: Reassue and dischage back to pimay cae.